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Chronic urinary retention from diabetic autonomic neuropathy — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Chronic urinary retention from diabetic autonomic neuropathyUSMLE Step 3

A 63-year-old man with long-standing diabetes has recurrent urinary tract infections and overflow incontinence. Postvoid residual volume is 650 mL. Prostate is mildly enlarged but not tender. Sensation in the feet is reduced. Which of the following is the most likely diagnosis?

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Correct answer: D — Diabetic autonomic neuropathy causing neurogenic bladder

High postvoid residual with overflow symptoms in long-standing diabetes suggests autonomic neuropathy with neurogenic bladder.

Reference: ADA Standards of Care in Diabetes 2026