Differential Diagnosis for Difficulty Urinating in a 74-Year-Old Man
Single Most Likely Diagnosis
- Benign Prostatic Hyperplasia (BPH): This condition is very common in older men and can cause urinary retention, especially at night. The prostate gland enlarges with age, potentially obstructing the flow of urine.
Other Likely Diagnoses
- Nocturia due to Sleep Disorders or Fluid Intake: Waking up at night to urinate could be related to sleep disorders or excessive fluid intake before bedtime, rather than a direct urinary tract issue.
- Overactive Bladder: This condition can cause a sudden, intense urge to urinate, which might be more noticeable at night.
- Urinary Tract Infection (UTI): Although less common in men, UTIs can cause discomfort and difficulty urinating.
- Diabetes: Uncontrolled diabetes can lead to polyuria (frequent urination), which might be more bothersome at night.
Do Not Miss Diagnoses
- Prostate Cancer: Although less likely than BPH, prostate cancer can also cause urinary obstruction symptoms and must be considered, especially in older men.
- Spinal Cord Injury or Disease: Conditions affecting the spinal cord, such as spinal stenosis or a tumor, can lead to neurogenic bladder, causing urinary retention or incontinence.
- Medication Side Effects: Certain medications, like anticholinergics or decongestants, can affect bladder function and cause urinary retention.
Rare Diagnoses
- Bladder Neck Contracture: A narrowing of the bladder neck that can cause obstructive urinary symptoms.
- Urethral Stricture: A narrowing of the urethra that can obstruct urine flow.
- Neurological Disorders (e.g., Multiple Sclerosis, Parkinson's Disease): These conditions can affect the nerves controlling the bladder, leading to urinary difficulties.
- Bladder Stones: Hard formations in the bladder that can cause obstructive symptoms.