Differential Diagnosis

The patient's symptoms of frequent urination, burning sensation, and small urine output, along with the variable response to ejaculation and bowel movements, suggest a complex interplay of urinary, neurological, and possibly gastrointestinal factors. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): This condition is characterized by chronic pain in the pelvic region, often accompanied by urinary symptoms such as frequency and urgency, and can be exacerbated by ejaculation. The variability in symptoms and the lack of clear dietary triggers also align with CP/CPPS.

• Other Likely Diagnoses

  • Overactive Bladder (OAB): The patient is already on Myrbetriq, which is used to treat OAB, suggesting that this diagnosis has been considered. Symptoms of OAB include urinary frequency, urgency, and nocturia, which align with the patient's complaints.
  • Benign Prostatic Hyperplasia (BPH): Although the patient has seen many urologists, BPH could still be a contributing factor, especially if there are elements of bladder outlet obstruction. However, the burning sensation and small urine output might not fully align with typical BPH symptoms.
  • Urethral Stricture: This could cause obstructive symptoms, including weak stream, straining to urinate, and possibly frequent urination due to incomplete bladder emptying. However, the primary symptom of a burning sensation during urination might not be as directly related.

• Do Not Miss Diagnoses

  • Urinary Tract Infections (UTIs): Recurrent or chronic UTIs could explain the symptoms of frequent urination and burning sensation. It's crucial to rule out UTIs, especially given the potential for severe consequences if left untreated, such as kidney damage.
  • Bladder Cancer: Although less likely given the patient's age and symptom duration, bladder cancer can cause irritative voiding symptoms, including frequency and urgency. Any hematuria (blood in the urine) would significantly increase the concern for this diagnosis.
  • Neurogenic Bladder: This condition, resulting from a neurological condition affecting bladder control, could lead to a variety of urinary symptoms, including those described. The relationship between bowel movements and urinary symptoms might hint at a neurogenic component.

• Rare Diagnoses

  • Eosinophilic Cystitis: A rare condition characterized by eosinophilic infiltration of the bladder wall, leading to symptoms that can mimic interstitial cystitis, including frequency, urgency, and pain.
  • Bladder Sphincter Dyssynergia: Typically seen in the context of neurological disorders, this condition involves coordination problems between the bladder and the urethral sphincter, leading to obstructive and irritative voiding symptoms.
  • Cystitis due to Other Infectious Agents: Such as tuberculosis or fungal infections, which could present with chronic urinary symptoms, including frequency and burning sensation, especially in immunocompromised patients.