Differential Diagnosis for 72 yo Male with Urinary Symptoms

The patient's symptoms of urge incontinence, dysuria, distal urethral pain with voiding, urinary frequency, and a slightly increased PSA over the last year suggest a range of possible diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Benign Prostatic Hyperplasia (BPH): This condition is common in older men and can cause urinary frequency, urgency, dysuria, and discomfort, especially with a slightly elevated PSA. BPH can lead to bladder outlet obstruction, which may result in the symptoms described.

• Other Likely Diagnoses

  • Prostatitis: Inflammation of the prostate can cause pain, urinary frequency, and dysuria. The slightly elevated PSA could also be consistent with prostatitis.
  • Urinary Tract Infection (UTI): Although more common in women, men can also develop UTIs, which can cause dysuria, frequency, and urgency.
  • Overactive Bladder: This condition can cause urge incontinence and frequency without an underlying neurological condition.

• Do Not Miss Diagnoses

  • Prostate Cancer: Although the PSA increase is described as slight, any increase warrants consideration of prostate cancer, especially in an older male. Prostate cancer can cause obstructive and irritative urinary symptoms.
  • Urethral Stricture: This condition can cause obstructive urinary symptoms and pain, especially with voiding. It's less common but important not to miss due to its impact on urinary function.
  • Neurogenic Bladder: Conditions affecting the nervous system, such as diabetes or spinal cord injuries, can lead to neurogenic bladder, causing a variety of urinary symptoms.

• Rare Diagnoses

  • Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can overlap with those described but are less common in men.
  • Urethral Cancer: Extremely rare but can cause similar symptoms, including pain and difficulty urinating.
  • Bladder Cancer: Can cause irritative symptoms and hematuria. While less likely than prostate issues in this demographic, it remains a consideration, especially with any hematuria or significant urinary symptoms.