Differential Diagnosis for a 49-year-old Lady with Urination Difficulty and Bulky Uterus
Single most likely diagnosis:
- Uterine Fibroids: The presence of a bulky uterus in conjunction with difficulty urinating (urinary retention) suggests that uterine fibroids could be compressing the urethra or bladder, leading to obstructive symptoms. The fact that there's no obstruction found in the renal tract or bladder voiding studies but the patient still experiences difficulty urinating points towards an external compression effect, which fibroids could cause.
Other Likely diagnoses:
- Pelvic Organ Prolapse: This condition, where the uterus or other pelvic organs bulge into the vagina, could also cause urinary retention by compressing the urethra.
- Urethral Stricture or Stenosis: Although less common in women, any narrowing of the urethra could lead to difficulty urinating.
- Neurogenic Bladder: Conditions affecting the nerves that control bladder function could lead to urinary retention, though this would typically be accompanied by other neurological symptoms.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Cancer of the Uterus or Cervix: Although less likely, any bulky uterus should prompt an investigation for malignancy, as both uterine and cervical cancers can present with a palpable mass and potentially cause urinary symptoms by compression or invasion of the bladder or ureters.
- Ovarian Cancer: Though primarily causing abdominal symptoms, advanced ovarian cancer can lead to pelvic compression symptoms, including urinary difficulties.
Rare diagnoses:
- Uterine Sarcoma: A rare type of uterine cancer that could present with a bulky uterus and potentially cause urinary symptoms.
- Endometriosis: In rare cases, severe endometriosis could lead to significant pelvic mass effect, potentially causing urinary retention, though this is less common.
- Pelvic Hematoma or Abscess: A collection of blood or pus in the pelvic region could compress the urinary tract, leading to retention, though this would typically be associated with significant pain and possibly fever.