Differential Diagnosis for 82-year-old Male with Hematuria and Dysuria
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The presence of leukocyte esterase, large blood, and symptoms like dysuria in an elderly patient strongly suggests a UTI. The glucose in the urine could be related to the infection itself or an underlying condition like diabetes.
Other Likely Diagnoses
- Kidney Stones: Hematuria and dysuria are common symptoms of kidney stones. Although the presence of leukocyte esterase and glucose might lean more towards an infection, stones can sometimes cause or be associated with infections.
- Prostate Issues (e.g., Prostatitis or Benign Prostatic Hyperplasia): In elderly males, prostate enlargement or prostatitis could cause urinary symptoms including dysuria and hematuria. The presence of glucose and leukocyte esterase might suggest an infectious component.
- Bladder Cancer: Although less common, bladder cancer should be considered in the differential diagnosis, especially in an elderly patient presenting with hematuria. However, the presence of leukocyte esterase and symptoms of infection might make this less likely as the primary diagnosis.
Do Not Miss Diagnoses
- Sepsis from a Urinary Source: In elderly patients, UTIs can quickly progress to sepsis, which is life-threatening. The presence of systemic symptoms (not mentioned but should be looked for) would increase the suspicion for sepsis.
- Pyelonephritis: An infection of the kidney, which can present with similar symptoms to a lower UTI but may have additional systemic symptoms like fever and flank pain. It's crucial not to miss this diagnosis due to its potential for serious complications.
Rare Diagnoses
- Tuberculosis of the Urinary Tract: Although rare in many parts of the world, urinary TB can cause hematuria, dysuria, and other urinary symptoms. It might be considered in patients with risk factors for TB or those who have not responded to standard UTI treatments.
- Interstial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can overlap with those of a UTI, but the absence of infection and the chronic nature of the symptoms might suggest this diagnosis. However, it's less likely given the acute presentation and presence of leukocyte esterase.