{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T13:16:18Z","timestamp":1783516578605,"version":"3.55.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Justus-Liebig-Universit\u00e4t Gie\u00dfen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2013bladder-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.<\/jats:p>","DOI":"10.1007\/s00192-026-06804-3","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T12:30:10Z","timestamp":1783513810000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Are We Missing the Bladder? Reflections on Endometriosis and IC\/BPS"],"prefix":"10.1007","author":[{"given":"Giovanni","family":"Di Favero","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Zeppernick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Zeppernick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Pfiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Schwandner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Meinhold-Heerlein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"issue":"4","key":"6804_CR1","doi-asserted-by":"publisher","DOI":"10.1093\/hropen\/hoab029","volume":"2021","author":"C Tomassetti","year":"2021","unstructured":"International Working Group of AAGL, ESGE, ESHRE and WES, Tomassetti C, Johnson NP, Petrozza J, Abrao MS, Einarsson JI, et al. An international terminology for endometriosis, 2021. Hum Reprod Open. 2021;2021(4):hoab029.","journal-title":"Hum Reprod Open"},{"issue":"9","key":"6804_CR2","doi-asserted-by":"publisher","first-page":"5927","DOI":"10.1097\/JS9.0000000000002647","volume":"111","author":"S Xu","year":"1990","unstructured":"Xu S, Zhang Y, Ye P, Huang Q, Wang Y, Zhang Y, et al. Global, regional, and national burden of endometriosis among women of childbearing age from 1990 to 2021: a cross-sectional analysis from the 2021 global burden of disease study. Int J Surg. 1990;111(9):5927\u201340.","journal-title":"Int J Surg"},{"key":"6804_CR3","unstructured":"- ACOG Committee on Practice Bulletins. Gynecology ACOG practice bulletin no. 11: medical management of endometriosis. Obstet Gynecol. 1999;94:1\u201314."},{"key":"6804_CR4","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/0090-4295(88)90238-5","volume":"32","author":"SI Sircus","year":"1988","unstructured":"Sircus SI, Sant GR, Ucci AA. Bladder detrusor endometriosis mimicking interstitial cystitis. Urology. 1988;32:339\u201342.","journal-title":"Urology"},{"issue":"1","key":"6804_CR5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/aogs.12026","volume":"92","author":"D Haas","year":"2013","unstructured":"Haas D, Shebl O, Shamiyeh A, Oppelt P. The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Acta Obstet Gynecol Scand. 2013;92(1):3\u20137.","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"7","key":"6804_CR6","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1111\/aogs.14099","volume":"100","author":"J Keckstein","year":"2021","unstructured":"Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, et al. The #Enzian classification: a comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand. 2021;100(7):1165\u201375.","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"10","key":"6804_CR7","doi-asserted-by":"publisher","first-page":"2359","DOI":"10.1093\/humrep\/deac187","volume":"37","author":"E Montanari","year":"2022","unstructured":"Montanari E, Bokor A, Szab\u00f3 G, Kondo W, Trippia CH, Malzoni M, et al. Comparison of #Enzian classification and revised American Society for Reproductive Medicine stages for the description of disease extent in women with deep endometriosis. Hum Reprod. 2022;37(10):2359\u201365.","journal-title":"Hum Reprod"},{"issue":"6","key":"6804_CR8","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1007\/s00404-025-08191-4","volume":"312","author":"L Hofbeck","year":"2025","unstructured":"Hofbeck L, Au K, Blum S, Sipulina N, Lotz L, Lermann JH, et al. Clinical characterization of endometriosis phenotypes. Arch Gynecol Obstet. 2025;312(6):2089\u2013100. https:\/\/doi.org\/10.1007\/s00404-025-08191-4.","journal-title":"Arch Gynecol Obstet"},{"issue":"5","key":"6804_CR9","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.jmig.2024.02.012","volume":"31","author":"C Bafort","year":"2024","unstructured":"Bafort C, Dancet E, Mellaerts J, Meuleman C, Tomassetti C. Correlation between surgical phenotype and pain improvement after endometriosis surgery. J Minim Invasive Gynecol. 2024;31(5):453-463.e4.","journal-title":"J Minim Invasive Gynecol"},{"key":"6804_CR10","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.bpobgyn.2020.11.004","volume":"71","author":"J Keckstein","year":"2021","unstructured":"Keckstein J, Hudelist G. Classification of deep endometriosis (DE) including bowel endometriosis: from r-ASRM to #Enzian-classification. Best Pract Res Clin Obstet Gynaecol. 2021;71:27\u201337.","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"5","key":"6804_CR11","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1016\/j.fertnstert.2024.07.009","volume":"122","author":"MS Kupka","year":"2015","unstructured":"Kupka MS, Chambers GM, Dyer S, Zegers-Hochschild F, de Mouzon J, Ishihara O, et al. International Committee for Monitoring Assisted Reproductive Technology world report: assisted reproductive technology, 2015 and 2016. Fertil Steril. 2015;122(5):875\u201393.","journal-title":"Fertil Steril"},{"issue":"2","key":"6804_CR12","doi-asserted-by":"publisher","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","volume":"2022","author":"CM Becker","year":"2022","unstructured":"Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009.","journal-title":"Hum Reprod Open"},{"issue":"1","key":"6804_CR13","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3390\/jcm15010030","volume":"15","author":"F Zeppernick","year":"2025","unstructured":"Zeppernick F, Balimuttajjo S, Schorr C, Sibelius F, Schuler M, Harth S, et al. Non-invasive diagnosis of endometriosis by questionnaires in patients using contraception. J Clin Med. 2025;15(1):30.","journal-title":"J Clin Med"},{"issue":"24","key":"6804_CR14","doi-asserted-by":"publisher","first-page":"3276","DOI":"10.3390\/healthcare13243276","volume":"13","author":"AI Gaia-Oltean","year":"2025","unstructured":"Gaia-Oltean AI, Boitor D, Pop LA, Galea G, Telecan T, Micu R. Non-invasive methods for early diagnosis of endometriosis-a comprehensive narrative literature review. Healthcare (Basel). 2025;13(24):3276.","journal-title":"Healthcare (Basel)"},{"issue":"3","key":"6804_CR15","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1055\/s-0045-1810431","volume":"43","author":"ML Falsetta","year":"2025","unstructured":"Falsetta ML, Chrysilla E. Current understanding of endometriosis pathophysiology and future perspectives. Semin Reprod Med. 2025;43(3):167\u201379.","journal-title":"Semin Reprod Med"},{"issue":"13","key":"6804_CR16","doi-asserted-by":"publisher","first-page":"5998","DOI":"10.3390\/ijms26135998","volume":"26","author":"FT Alotaibi","year":"2025","unstructured":"Alotaibi FT. Pathophysiology of endometriosis: insights from immunohistochemical analysis of ectopic and eutopic tissues. Int J Mol Sci. 2025;26(13):5998.","journal-title":"Int J Mol Sci"},{"issue":"6","key":"6804_CR17","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.3390\/ijms26062458","volume":"26","author":"H Mariadas","year":"2025","unstructured":"Mariadas H, Chen JH, Chen KH. The molecular and cellular mechanisms of endometriosis: from basic pathophysiology to clinical implications. Int J Mol Sci. 2025;26(6):2458.","journal-title":"Int J Mol Sci"},{"issue":"7","key":"6804_CR18","doi-asserted-by":"publisher","first-page":"827","DOI":"10.3390\/ph17070827","volume":"17","author":"M Sad\u0142ocha","year":"2024","unstructured":"Sad\u0142ocha M, Toczek J, Major K, Staniczek J, Stojko R. Endometriosis: molecular pathophysiology and recent treatment strategies-comprehensive literature review. Pharmaceuticals (Basel). 2024;17(7):827.","journal-title":"Pharmaceuticals (Basel)"},{"key":"6804_CR19","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.fertnstert.2018.10.013","volume":"111","author":"PR Koninckx","year":"2019","unstructured":"Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V. Pathogenesis of endometriosis: the genetic\/epigenetic theory. Fertil Steril. 2019;111:327\u201340.","journal-title":"Fertil Steril"},{"key":"6804_CR20","doi-asserted-by":"publisher","first-page":"961599","DOI":"10.3389\/fimmu.2022.961599","volume":"13","author":"A McCallion","year":"2022","unstructured":"McCallion A, Falconer H, Widschwendter M, Horne AW. Estrogen mediates inflammatory role of mast cells in endometriosis pathophysiology. Front Immunol. 2022;13:961599.","journal-title":"Front Immunol"},{"key":"6804_CR21","doi-asserted-by":"publisher","first-page":"312","DOI":"10.3390\/diagnostics14030312","volume":"14","author":"IE Oal\u0103","year":"2024","unstructured":"Oal\u0103 IE, Dumitrescu LS, Mihu CM, Gluhovschi A, Manea M, Nemeti G, et al. Endometriosis and the role of pro-inflammatory and anti-inflammatory cytokines in pathophysiology: a narrative review of the literature. Diagnostics. 2024;14:312.","journal-title":"Diagnostics"},{"key":"6804_CR22","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24054254","volume":"24","author":"J Lamceva","year":"2023","unstructured":"Lamceva J, Uljanovs R, Strumfa I. The main theories on the pathogenesis of endometriosis. Int J Mol Sci. 2023;24:4254.","journal-title":"Int J Mol Sci"},{"issue":"10","key":"6804_CR23","volume":"14","author":"A Juganavar","year":"2022","unstructured":"Juganavar A, Joshi KS. Chronic pelvic pain: a comprehensive review. Cureus. 2022;14(10):e30691.","journal-title":"Cureus"},{"issue":"2","key":"6804_CR24","doi-asserted-by":"publisher","first-page":"E141","DOI":"10.36076\/ppj.2014\/17\/E141","volume":"17","author":"A Ahangari","year":"2014","unstructured":"Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141-7.","journal-title":"Pain Physician"},{"key":"6804_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-6-177","volume":"6","author":"P Latthe","year":"2006","unstructured":"Latthe P, Latthe M, Say L, G\u00fclmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006;6:177.","journal-title":"BMC Public Health"},{"key":"6804_CR26","unstructured":"American College of Obstetricians and Gynecologists. ReVitalize. Gynecology Data Definitions; American College of Obstetric and Gynecology (ACOG): Washington, DC, USA, 2018."},{"key":"6804_CR27","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.jogc.2021.08.011","volume":"44","author":"G Huang","year":"2022","unstructured":"Huang G, Le A-L, Goddard Y, James D, Thavorn K, Payne M, et al. A systematic review of the cost of chronic pelvic pain in women. J Obstet Gynaecol Can. 2022;44:286-293.e3.","journal-title":"J Obstet Gynaecol Can"},{"issue":"1","key":"6804_CR28","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1097\/00003081-199003000-00018","volume":"33","author":"RC Reiter","year":"1990","unstructured":"Reiter RC. A profile of women with chronic pelvic pain. Clin Obstet Gynecol. 1990;33(1):130\u20136.","journal-title":"Clin Obstet Gynecol"},{"key":"6804_CR29","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.neuron.2007.07.012","volume":"55","author":"I Tracey","year":"2007","unstructured":"Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55:377\u201391.","journal-title":"Neuron"},{"key":"6804_CR30","doi-asserted-by":"publisher","first-page":"291","DOI":"10.36076\/ppj.2013\/16\/291","volume":"16","author":"S Kaya","year":"2013","unstructured":"Kaya S, Hermans L, Willems T, Roussel N, Meeus M. Literature review central sensitization in urogynecological chronic pelvic pain: a systematic literature review. Pain Physician. 2013;16:291\u2013308.","journal-title":"Pain Physician"},{"key":"6804_CR31","volume":"12","author":"A Inzoli","year":"2024","unstructured":"Inzoli A, Barba M, Costa C, Carazita V, Cola A, Fantauzzi M, et al. The evil twins of chronic pelvic pain syndrome: a systematic review and meta-analysis on interstitial cystitis\/painful bladder syndrome and endometriosis. Healthcare (Basel, Switzerland). 2024;12:2403.","journal-title":"Healthcare (Basel, Switzerland)"},{"issue":"1","key":"6804_CR32","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1097\/AOG.0000000000006123","volume":"147","author":"S As-Sanie","year":"2026","unstructured":"As-Sanie S, Ross WT, Till SR. Evaluation and treatment of chronic pelvic pain. Obstet Gynecol. 2026;147(1):21\u201343.","journal-title":"Obstet Gynecol"},{"key":"6804_CR33","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.eururo.2009.08.020","volume":"57","author":"M Fall","year":"2010","unstructured":"Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2010;57:35\u201348.","journal-title":"Eur Urol"},{"key":"6804_CR34","doi-asserted-by":"crossref","unstructured":"Hanno PM, Burks DA, Clemens JQ, Dmochowski RR, Erickson D, Fitzgerald MP, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis\/bladder pain syndrome. J Urol. 2011;185(6):2162\u201370.","DOI":"10.1016\/j.juro.2011.03.064"},{"key":"6804_CR35","unstructured":"International Continence Society. Terminology discussion: Interstitial Cystitis\/Bladder Pain Syndrome (IC\/BPS) [Internet]. [cited 2025 Jul 29]. Available from: https:\/\/www.ics.org\/committees\/standardisation\/terminologydiscussions\/icbps"},{"key":"6804_CR36","unstructured":"Engeler D. European Association of Urology. Guidelines on Bladder Pain Syndrome\/Interstitial Cystitis. 2024. https:\/\/uroweb.org\/guidelines\/chronic-pelvic-pain."},{"key":"6804_CR37","doi-asserted-by":"publisher","first-page":"2051","DOI":"10.3390\/biomedicines12092051","volume":"12","author":"W-R Yu","year":"2024","unstructured":"Yu W-R, Jhang J-F, Jiang Y-H, Kuo H-C. The pathomechanism and current treatments for chronic interstitial cystitis and bladder pain syndrome. Biomedicines. 2024;12:2051.","journal-title":"Biomedicines"},{"key":"6804_CR38","unstructured":"Chung MK, Chung RR, Gordon D, Jennings C. The evil twins of chronic pelvic pain syndrome: endometriosis and interstitial cystitis. JSLS. 2002;6(4):311\u20134."},{"issue":"3","key":"6804_CR39","first-page":"10257","volume":"27","author":"TL Overholt","year":"2020","unstructured":"Overholt TL, Evans RJ, Lessey BA, Matthews CA, Hines KN, Badlani G, et al. Non-bladder centric interstitial cystitis\/bladder pain syndrome phenotype is significantly associated with co-occurring endometriosis. Can J Urol. 2020;27(3):10257\u201362.","journal-title":"Can J Urol"},{"key":"6804_CR40","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.1016\/S0022-5347(05)65517-6","volume":"166","author":"A Driscoll","year":"2001","unstructured":"Driscoll A, Teichman JM. How do patients with interstitial cystitis present? J Urol. 2001;166:2118\u201320.","journal-title":"J Urol"},{"issue":"5A Suppl","key":"6804_CR41","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/S0090-4295(99)80333-1","volume":"49","author":"MP O'Leary","year":"1997","unstructured":"O\u2019Leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J. The interstitial cystitis symptom index and problem index. Urology. 1997;49(5A Suppl):58\u201363.","journal-title":"Urology"}],"container-title":["International Urogynecology Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06804-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-026-06804-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06804-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T12:30:12Z","timestamp":1783513812000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00192-026-06804-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":41,"alternative-id":["6804"],"URL":"https:\/\/doi.org\/10.1007\/s00192-026-06804-3","relation":{},"ISSN":["0937-3462","1433-3023"],"issn-type":[{"value":"0937-3462","type":"print"},{"value":"1433-3023","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"assertion":[{"value":"13 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}}]}}