Differential Diagnosis for Urinary Incontinence in an Old Lady with DM and Hypertension

• Single Most Likely Diagnosis
  • C. Overflow incontinence: This is the most likely diagnosis given the high residual bladder volume (60-80 mL) shown on USS, indicating that the bladder is not fully emptying. This condition can be caused by various factors including diabetes (diabetic cystopathy), which can lead to neurogenic bladder, but the immediate cause of incontinence in this context is the overflow due to incomplete bladder emptying.
• Other Likely Diagnoses
  • D. Diabetic cystopathy: Given the patient's history of diabetes, diabetic cystopathy is a plausible cause. It can lead to a neurogenic bladder, which might result in urinary retention and subsequently overflow incontinence.
  • B. Functional incontinence: Considering the patient's history of a previous left hemisphere infarction, she might have cognitive or mobility issues that could lead to functional incontinence, where she is unable to reach the toilet in time due to her physical or cognitive limitations.
• Do Not Miss Diagnoses
  • A. Normal pressure hydrocephalus (NPH): Although less likely, NPH is a condition that can cause urinary incontinence, gait disturbances, and dementia. It's crucial not to miss this diagnosis because it is potentially treatable with the placement of a ventriculoperitoneal shunt, which can significantly improve symptoms.
• Rare Diagnoses
  • Other rare causes of urinary incontinence might include spinal cord injuries, multiple sclerosis, or other neurodegenerative diseases that could affect bladder control. However, given the patient's provided history, these would be less likely and are not explicitly listed among the options.