Differential Diagnosis for a 65-year-old patient with straining during defecation and urination, prostatomegaly, and chronic bladder wall thickening

• Single most likely diagnosis:
  • Benign Prostatic Hyperplasia (BPH) - This condition is very common in older men and can cause urinary retention, straining during urination, and bladder wall thickening due to the obstruction caused by the enlarged prostate. The symptoms and findings are classic for BPH.
• Other Likely diagnoses:
  • Prostate Cancer - While less common than BPH, prostate cancer can also cause prostatomegaly and urinary symptoms. The chronic bladder wall thickening could be a result of long-standing obstruction.
  • Chronic Prostatitis - This condition can cause urinary symptoms and prostatomegaly, although it is less likely to cause significant bladder wall thickening.
  • Neurogenic Bladder - Conditions affecting the nerves controlling the bladder can lead to urinary retention and bladder wall thickening, but prostatomegaly would not be a direct result of this condition.
• Do Not Miss diagnoses:
  • Bladder Outlet Obstruction due to other causes (e.g., bladder neck contracture, urethral stricture) - These conditions can present similarly to BPH and prostate cancer but require different management.
  • Urinary Retention due to Medication Side Effects - Certain medications can cause urinary retention, which could lead to bladder wall thickening if not promptly addressed.
• Rare diagnoses:
  • Prostatic Abscess - A rare condition that could cause prostatomegaly and systemic symptoms, but it would typically present with more acute symptoms.
  • Bladder Cancer - While bladder cancer can cause urinary symptoms and bladder wall thickening, it is less likely to cause prostatomegaly directly.
  • Pelvic Floor Dysfunction - This can cause straining during defecation but is less directly related to the urinary symptoms and prostatomegaly described.