Differential Diagnosis for Bladder Pain

The patient presents with bladder pain, frequent urination, and a family history of prostate cancer. The following differential diagnosis is organized into categories:

• Single Most Likely Diagnosis
  • Overactive Bladder (OAB): The patient's symptoms of frequent urination (over 20 times a day) and the feeling of incomplete bladder emptying are consistent with OAB. The recent increase in urination frequency after starting HCTZ, a diuretic, further supports this diagnosis.
• Other Likely Diagnoses
  • Urinary Tract Infection (UTI): The patient's bladder pain and frequent urination could be indicative of a UTI, especially if the pain worsens with coughing, which can put pressure on the bladder.
  • Benign Prostatic Hyperplasia (BPH): Given the patient's family history of prostate cancer and symptoms of frequent urination and incomplete bladder emptying, BPH is a possible diagnosis. However, the patient's age and lack of other BPH symptoms (e.g., weak stream, hesitancy) make it less likely.
  • Interstitial Cystitis (IC): The patient's bladder pain and frequent urination could be consistent with IC, a chronic condition characterized by bladder pain and urgency.
• Do Not Miss Diagnoses
  • Prostate Cancer: Although the patient's symptoms are not strongly suggestive of prostate cancer, the family history and ED symptoms warrant consideration of this diagnosis to avoid missing a potentially life-threatening condition.
  • Bladder Cancer: Similar to prostate cancer, bladder cancer is a less likely diagnosis but must be considered due to the potential severity of the condition.
  • Kidney Stones: The patient's bladder pain and frequent urination could be indicative of kidney stones, which can cause severe pain and require prompt medical attention.
• Rare Diagnoses
  • Bladder Outlet Obstruction: This condition, often caused by BPH or other obstructive lesions, could lead to symptoms of frequent urination and incomplete bladder emptying.
  • Neurogenic Bladder: A condition resulting from nerve damage affecting bladder function, which could cause a range of urinary symptoms, including frequency and urgency.
  • Bladder Fistula: An abnormal connection between the bladder and another organ (e.g., bowel, vagina) could cause urinary symptoms, including frequency and pain.