Are We Missing the Bladder? Reflections on Endometriosis and IC/BPS

Area of Science:

• Gynecology
• Urology
• Pain Medicine

Background:

• Endometriosis and interstitial cystitis/bladder pain syndrome (IC/BPS) are common causes of chronic pelvic pain in women.
• Overlapping symptoms and diagnostic challenges often lead to delayed recognition of coexisting endometriosis and IC/BPS.

Purpose of the Study:

• To propose a structured surgical approach combining laparoscopy and diagnostic cystoscopy for improved identification and characterization of dual endometriosis and IC/BPS pathology.
• To differentiate bladder-centric and non-bladder-centric IC/BPS phenotypes using optical assessment during surgery.

Main Methods:

• Prospective surgical experience in women with suspected endometriosis and bladder symptoms.
• Integration of laparoscopy with diagnostic cystoscopy for simultaneous evaluation.
• Phenotypic differentiation of IC/BPS based on cystoscopic findings.

Main Results:

• Surgical assessment enables phenotypic differentiation of IC/BPS in women with endometriosis.
• Identification of cystoscopic features guides the initiation of bladder-directed therapy.
• Combined approach enhances diagnostic precision and supports individualized treatment.

Conclusions:

• A structured surgical approach integrating laparoscopy and cystoscopy improves the diagnosis of coexisting endometriosis and IC/BPS.
• Integrated diagnostic algorithms and multidisciplinary care are crucial for managing the complex interplay between these conditions.
• This approach has the potential to minimize incomplete interventions and enhance symptom control for improved patient outcomes.