Differential Diagnosis for Pain with Urination at the End of Voiding

• Single most likely diagnosis
  • Prostatitis: This condition, particularly chronic prostatitis, often presents with pain at the end of urination due to the prostate gland's location and its effect on the urethra during the final stages of voiding.
• Other Likely diagnoses
  • Urethral stricture: Narrowing of the urethra can cause pain during urination, especially towards the end, as the urethra struggles to pass urine through the narrowed segment.
  • Urethritis: Inflammation of the urethra can lead to pain during urination, which may be more pronounced at the end of voiding due to the urethra's sensitivity.
  • Bladder neck contracture: Similar to a urethral stricture, a contracture at the bladder neck can cause obstructive symptoms and pain, particularly at the end of urination.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cancer of the prostate or bladder: Although less common, cancers in these areas can present with urinary symptoms, including pain at the end of urination. Early detection is crucial for effective treatment.
  • Kidney stones: While stones often cause more severe, colicky pain, smaller stones or those in specific locations might cause pain during urination, especially if they are moving or obstructing the flow.
• Rare diagnoses
  • Interstitial cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can worsen with bladder filling and may improve with urination, but in some cases, could be perceived as worsening towards the end of voiding.
  • Urethral diverticulum: An outpouching of the urethral wall can cause a variety of urinary symptoms, including pain during urination, which might be more noticeable at the end of voiding due to changes in urethral pressure.