Did your urine cultures show any growth? Has your treating urologist performed a cystoscope on you and if so has he biopsies any tissue? I’m in agreement with the 2nd opinion idea too. Since you may have had a lot of studies done already I hope, you or urologists (if they are willing) contact a Seattle University Hospital via videoconference. This is the easiest way to determine if you need to go somewhere else. I realize you’re in a somewhat remote location being in Alaska with limited healthcare providers so try and get as much done remotely. If your resources for adequate healthcare are too limited you may have to head to the south to the 48. If you have traditional Medicare with a medi-gap plan you can go pretty much go anywhere. Mayo is also in Minnesota if that helps. I certainly hope you get obtain relief soon and good luck.