Differential Diagnosis for Urinary Retention in an Elderly Male

The patient's symptoms of urinary retention, urgency, and a small amount of urine in the bladder can be caused by various conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Benign Prostatic Hyperplasia (BPH): This condition is very common in elderly males and can cause urinary retention, urgency, and a decrease in the force of the urine stream. The prostate gland enlarges, obstructing the flow of urine.

• Other Likely Diagnoses

  • Urinary Tract Infection (UTI): UTIs can cause symptoms of urgency and retention, especially in elderly males. The infection can irritate the bladder and urethra, leading to these symptoms.
  • Neurogenic Bladder: This condition occurs when there is a problem with the nerves that control the bladder, often due to diabetes, stroke, or spinal cord injury. It can cause a range of urinary symptoms, including retention and urgency.
  • Prostate Cancer: Although less common than BPH, prostate cancer can also cause urinary retention and urgency by obstructing the urethra.

• Do Not Miss Diagnoses

  • Spinal Cord Compression: This is a medical emergency that can cause neurogenic bladder symptoms, including urinary retention. It is crucial to identify and treat promptly to prevent permanent damage.
  • Bladder Outlet Obstruction due to Bladder Stones or Blood Clots: These can cause sudden and severe urinary retention and must be treated urgently to relieve the obstruction.
  • Acute Kidney Injury: Although less directly related to the symptoms, acute kidney injury can lead to a decrease in urine production, which might be mistaken for retention. Identifying and treating the cause of kidney injury is critical.

• Rare Diagnoses

  • Bladder Sclerosis: A rare condition where the bladder wall becomes thickened and scarred, leading to a decrease in bladder capacity and symptoms of urgency and retention.
  • Detrusor Underactivity: A condition where the muscle in the bladder wall (detrusor muscle) does not contract properly, leading to difficulty emptying the bladder and symptoms of retention.
  • Urethral Stricture: Narrowing of the urethra, which can cause obstructive urinary symptoms, including retention. This is less common in the absence of a history of trauma, infection, or instrumentation.