Differential Diagnosis for an 85-year-old Male with Dysuria and Penile Pain during Urination
- Single most likely diagnosis:
- Urinary Tract Infection (UTI): This is the most likely diagnosis given the symptoms of dysuria and penile pain during urination. UTIs are common in older adults and can present with these symptoms, especially in the absence of other systemic symptoms like fever.
- Other Likely diagnoses:
- Prostatitis: Although the patient has no history of prostate enlargement, prostatitis can still occur and cause dysuria and pain. The absence of CVA tenderness does not rule out this diagnosis entirely.
- Urethritis: This condition, often caused by infections, can lead to dysuria and pain during urination. It's a plausible diagnosis given the patient's symptoms.
- Benign Prostatic Hyperplasia (BPH) with urinary retention: Despite no prior history, BPH could be a new development causing obstructive symptoms like dysuria.
- Do Not Miss diagnoses:
- Kidney stones: Although the patient does not have nausea or fevers, kidney stones can cause severe pain and dysuria. Missing this diagnosis could lead to severe complications if the stone causes an obstruction.
- Epididymitis or orchitis: These conditions can cause pain and might be associated with urinary symptoms. They are important to consider due to the potential for severe complications if not treated promptly.
- Malignancy (e.g., prostate, bladder, or penile cancer): Although less likely, these conditions can present with urinary symptoms and are critical not to miss due to their potential impact on mortality and morbidity.
- Rare diagnoses:
- Interstitial cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can overlap with those of a UTI but are less common.
- Neurogenic bladder: Given the patient's age, a neurogenic cause of bladder dysfunction could be considered, especially if there are underlying neurological conditions not mentioned.
- Foreign body in the urethra: Although rare, this could cause the symptoms described and is an important consideration to rule out, especially if the patient has a history of dementia or other cognitive impairments that might lead to such an incident.