Differential Diagnosis

The patient's symptoms of hesitancy, intermittency, and loss of libido can be approached by considering various potential causes. 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 symptoms such as hesitancy and intermittency due to prostate enlargement. The loss of libido could be related to hormonal changes or the psychological impact of urinary symptoms.

• Other Likely Diagnoses

  • Prostatitis: Inflammation of the prostate can cause urinary symptoms similar to BPH, along with pain and potentially affect libido.
  • Erectile Dysfunction: While primarily associated with sexual performance, erectile dysfunction can also lead to a decrease in libido and may be related to or exacerbate urinary symptoms.
  • Diabetes Mellitus: Can cause urinary symptoms due to neuropathy and may also lead to erectile dysfunction and decreased libido.
  • Hypogonadism: Low testosterone levels can directly cause a decrease in libido and may also contribute to urinary symptoms.

• Do Not Miss Diagnoses

  • Prostate Cancer: Although less likely than BPH to cause these specific symptoms, prostate cancer is a critical diagnosis not to miss due to its potential severity and the importance of early detection.
  • Neurological Disorders (e.g., Multiple Sclerosis, Spinal Cord Injury): These can cause urinary retention or incontinence and sexual dysfunction, including loss of libido.
  • Urethral Stricture: A narrowing of the urethra can cause obstructive urinary symptoms.

• Rare Diagnoses

  • Peyronie's Disease: A condition characterized by the development of fibrous scar tissue inside the penis, leading to curved, painful erections, which might indirectly affect libido and urinary function.
  • Endocrine Disorders (e.g., Hyperprolactinemia): Can affect libido and potentially contribute to urinary symptoms through various mechanisms, including hormonal imbalances.
  • Certain Medications: Some medications can cause sexual dysfunction and urinary symptoms as side effects, though this would typically be identified through a thorough medication history.