Differential Diagnosis for a 73-year-old Male with Urinary Symptoms
Single Most Likely Diagnosis
- Benign Prostatic Hyperplasia (BPH): The patient's symptoms of daytime urgency, frequency, nocturia, and slow stream, along with the ultrasound finding of a significantly enlarged prostate (59g), strongly suggest BPH as the primary cause of his symptoms.
Other Likely Diagnoses
- Chronic Kidney Disease: The presence of a 4.2 cm cyst in the left kidney could be indicative of underlying kidney disease, although the absence of hydronephrosis and the normal size of the kidneys make this less likely.
- Urinary Tract Infection (UTI): Although the patient denies dysuria and fever, UTIs can sometimes present with minimal symptoms, especially in older adults. The absence of hematuria and negative findings on the pelvic sonogram make this less likely but still a consideration.
- Overactive Bladder: The symptoms of urgency and frequency could also be attributed to an overactive bladder, which is common in older adults.
Do Not Miss Diagnoses
- Prostate Cancer: Given the patient's age and the finding of a heterogeneous prostate, although the primary suspicion is BPH, prostate cancer must be considered and ruled out due to its potential severity and impact on mortality.
- Kidney Cancer: The presence of a cyst in the kidney warrants consideration of renal cell carcinoma, although the sonogram did not indicate any suspicious features of the cyst.
- Bladder Cancer: Despite the absence of hematuria and normal bladder appearance on sonography, bladder cancer can sometimes present with irritative symptoms like urgency and frequency, making it a diagnosis that should not be missed.
Rare Diagnoses
- Interstitial Cystitis: A condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain, which could explain some of the patient's symptoms, although it is less common in men.
- Neurogenic Bladder: This condition, resulting from a neurological condition affecting bladder control, could potentially cause the patient's symptoms but would typically be associated with other neurological signs or symptoms.
- Urethral Stricture: Although less common, could cause obstructive symptoms similar to BPH, but would typically present with a more significant obstructive symptom profile.