A 69 yr old with T2DM, BPH, and HTN is presenting with dysuria, blood in urine, and fatigue. He has a 6-month history of increased urinary frequency with small volume and nighttime urination. He has had 2 episodes of cystitis in the past 8 months. Temp is 100.9. PE has suprapubic tenderness and soft enlarged prostate. US shows bladder diverticulum and enlarged KIDNEYS with dilation of renal pelvis and calyces. He has E. coli in urine culture. Underlying cause?
a) Vesicoureteral reflux
b) Bladder outlet obstruction
c) Renal calculi
d) Renal cell carcinoma