A patient 45 years of age, non diabetic, presents with chronic pelvic pain of 1 year duration. She also complains of frequency, urgency and a sense of incomplete evacuation since 1 year without any significant finding on her past ultrasounds, urine examination and urine and high vaginal swab cultures. On pelvic examination there is no significant vaginal discharge. Cystoscopy is normal. Most probable diagnosis is

Urethral syndrome Urethral syndrome is defined as a symptom complex including dysuria, frequency, urgency, suprapubic discomfo , post void fullness and dyspareunia in the absence of any abnormality of urethra or bladder. Cause is unceain and is attributed to subclinical infection, urethral obstruction, psychogenic and allergic factors. It is a diagnosis of exclusion, after ruling out UTI, malignancy, vulvovaginitis. Cystoscopy to rule out urethral diveiculum, stones and malignancy. Management: multidisciplinary approach, antibiotics for sterile pyuria. Post menopausal women may benefit from local estrogen. Physical therapy, cognitive-behavioral therapy and psycological suppo. Asymptomatic bacteriuria is ruled out with normal urine culture, Cystitis with normal urine r/m, c/s, and USG. Vulvovaginitis is ruled out by the given symptoms and normal local examination