The probable diagnoses for the elderly man presenting with acute urinary retention and a history of thin stream of urine and urgency over the past 3 years include:
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- **Benign Prostatic Hyperplasia (BPH)**: This is a common condition in older men characterized by the enlargement of the prostate gland, leading to urinary symptoms such as hesitancy, weak urinary stream, urgency, and in severe cases, acute urinary retention.
- **Prostate Cancer**: Prostate cancer can also present with urinary symptoms similar to those of BPH, including difficulty initiating urination, weak urinary stream, and urinary retention. However, acute urinary retention is less common in prostate cancer compared to BPH.
Investigations that would be important to perform in this patient include:
- **Digital Rectal Examination (DRE)**: DRE is a physical examination performed by a healthcare provider to assess the size, consistency, and texture of the prostate gland. In BPH, the prostate gland may feel enlarged, firm, and smooth. In prostate cancer, there may be nodules or irregularities detected upon palpation.
- **Transrectal Ultrasound (TRUS)**: TRUS is a non-invasive imaging test that uses sound waves to create images of the prostate gland. It can provide valuable information about the size and structure of the prostate gland, as well as detect any abnormalities such as nodules or tumors. TRUS is commonly used to evaluate prostate volume and guide prostate biopsy in patients suspected of having prostate cancer.
These investigations can help confirm the underlying cause of the patient’s urinary symptoms and guide further management decisions, including treatment options such as medication therapy, minimally invasive procedures, or surgery, depending on the diagnosis.