Differential Diagnosis for a 93-year-old with Symptoms Suggestive of Overactive Bladder (OAB) or Benign Prostatic Hyperplasia (BPH)

Single Most Likely Diagnosis

• Benign Prostatic Hyperplasia (BPH): Given the patient's age and gender, BPH is highly prevalent and can cause lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, and nocturia, which overlap with symptoms of overactive bladder. The likelihood of BPH increases with age, making it a prime consideration in this demographic.

Other Likely Diagnoses

• Overactive Bladder (OAB): Characterized by urinary urgency, usually accompanied by frequency and nocturia, with or without urge urinary incontinence. In older adults, OAB can be due to a variety of factors including detrusor overactivity, which is common in this age group.
• Urinary Tract Infection (UTI): Especially in elderly patients, UTIs can present with symptoms of urgency, frequency, and dysuria, mimicking OAB or exacerbating BPH symptoms.
• Detrusor Overactivity: A urodynamic observation characterized by an involuntary detrusor contraction during the filling phase, which can be a cause of OAB symptoms.

Do Not Miss Diagnoses

• Prostate Cancer: Although less likely than BPH, prostate cancer can also cause obstructive and irritative urinary symptoms. Given the potential severity of this diagnosis, it is crucial not to miss it, especially in older men.
• Neurogenic Bladder: Conditions affecting the brain, spinal cord, or peripheral nerves can lead to neurogenic bladder, presenting with a variety of urinary symptoms. In a 93-year-old, conditions like stroke, Parkinson's disease, or spinal cord injuries could be underlying causes.
• Bladder Outlet Obstruction (BOO) due to other causes: Such as bladder neck contracture, urethral stricture, or stones, which can present similarly to BPH.

Rare Diagnoses

• Interstitial Cystitis/Bladder Pain Syndrome: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can overlap with OAB but typically include pain, which is not always present in OAB or BPH.
• Diabetes Insipidus or Diabetes Mellitus: Can cause polyuria leading to symptoms of frequency and nocturia, mimicking OAB or BPH.
• Medication-induced urinary symptoms: Certain medications can exacerbate or induce urinary symptoms similar to OAB or BPH, such as diuretics, sedatives, and anticholinergics.

Each of these diagnoses requires careful consideration of the patient's medical history, physical examination, and potentially, urodynamic studies or imaging to accurately diagnose and manage the condition.