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

Endometriosis and interstitial cystitis/bladder pain syndrome (IC/BPS) frequently coexist in women with chronic pelvic pain, yet overlapping symptoms and non-standardized diagnostic pathways often delay recognition of dual pathology. We propose that a structured surgical approach combining laparoscopy and diagnostic cystoscopy may improve identification and clinical characterization of this overlap. On the basis of prospective surgical experience in women with suspected endometriosis and concomitant bladder symptoms, optical assessment enables phenotypic differentiation of bladder-centric and non-bladder-centric IC/BPS. When cystoscopic features are present, initiation of a standardized bladder-directed therapeutic strategy alongside endometriosis treatment may enhance symptom control and reduce persistent pain. Systematic evaluation during a single surgical setting has the potential to increase diagnostic precision, minimize incomplete interventions, and support individualized, mechanism-based management. This opinion highlights the importance of integrated diagnostic algorithms and multidisciplinary care models to address the complex interplay between endometriosis and IC/BPS.