What could be going on with my bladder/kidneys?

29M / 150lbs / 5’7

Ref: please ignore the aspects of this post that touch upon images; I’m cross-posting & images can’t be attached here.

For around 8 months now I’ve had increased urinary frequency and urge - initial thoughts from PCP was a UTI even though I showed no infection markers on a dip/urine cytology/microscope test @ lab referral etc. all that ever gets noted on my dips are micro traces of blood but less than the ‘concern’ amount (never used to have this show on urine tests previously). No pain on passing urine, no burning, no discharge etc. This increased urgency is accompanied by pelvic/bladder pain (if I brace my core, it’s uncomfortable almost 24/7) & the cloudy urine in the images above often is accompanied by stringy white particles. This has been tested in the lab and simply comes back as ‘sediment heavy - no infection’. These voids are often 150-300ml with the most common being 200ml voids every hour-90mins or so if I’m trying to restrict fluid intake slightly. If I up my fluids to even 2L of plain water a day it’s easily 200-250ml voids every 25minutes until I stop producing urine.

The cloudy urine can occur regardless of how hydrated I am - one moment a void can look like the clear picture example, the next like the cloudy example. When you add vinegar to the cloudy urine it clears up which I have read = high in phosphates; this initially checked out as I often eat protein dense meals and these episodes would occur following this. However, I’ve tried elimination diets, fasting, over-hydrating and dehydrating.. irrespective of the above I can either pass clear or cloudy urine. There is no pattern at all. It is less likely when I’m very hydrated, but the issue with a higher fluid intake in my case is I will be voiding 200-300ml every 20 minutes until I’ve seemingly emptied. It feels like my kidneys work overtime to produce urine / overactive bladder tendencies in these instances. Also my urine during these overactive periods with high fluid intake = clear as water by the time I’m finished with the every 20min bathroom visits. Never any cloudy episodes in these instances.

I’ve been on antibiotics ranging from Nitrofurantoin, doxycycline and trimethoprim (the first two to rule out UTIs/non-specific urethritis, Trim was to rule out a case of prostatitis, rectal exam was completely normal) - should also note here that all STD checks came back normal too.

My symptoms progressed to affect sexual function as it always feels like a ‘tingle’ in the urethra / penis head during flares. My urge to urinate doesn’t feel at all like it used to; if I consume heavy fluids it’s simply an ‘ache’ that builds instead of that ‘bursting for the toilet’ feeling you associate with. Pressure/flow feels worse. Almost like a nerve issue in terms of my bladder signals & lack of real relief after a void. It’s almost like it has numbed my pleasure receptors too; I cant remember the last time I felt ‘horny’ due to this. Had testosterone & bloods carried out multiple times and no red flags. No issue with kidney function etc. Should also note that I’ve had almost zero morning wood for the last year or so, whether that’s down to anxiety of this developing, or worse circulation due to sedentary habits/pelvic floor dysfunction I have no idea. I’ve had periods of heavy fat loss & also the inverse whilst training at the gym; I do not feel notably better or worse hormonally speaking on either end of the spectrum of dieting.

I am active in the gym with regards to weightlifting but otherwise have led a very sedentary lifestyle the last 8 years; work from home job, gaming etc. I suspected my pelvic floor muscles were playing a role in things such as weaker erections & urinary flow/hesitancy/post urination dribble/what get like issues ‘fully emptying’ & began stretching routines months ago. Also became more active with cardio for vascular health & general fitness.

I’ve been on a urology waiting list for over 7 months. Urgent referral for ultrasound due to consistent complaints has still not been sorted after 7 weeks. This is to rule out abnormalities & kidney stones (which I suspect \*could\* be at play, due to some occasional flank and lower back pain flares but nothing like I’d assume kidney stones would cause). Any online search simply assumes cloudy urine = infection or benign causes with links to internal cystitis. I’m not even particularly concerned regarding the urine appearance at this point but instead the almost debilitating affects surrounding it. Even when ‘aroused’ I can still pass 100-200ml of fluid & it barely alleviates the ‘tingle’ feeling in the urethra.