(Poster 146) Endometriosis in Patients with Female Bladder Pain Syndrome

Objectives: Female Bladder Pain Syndrome (FBPS), previously known as interstitial cystitis/bladder pain syndrome, is a debilitating chronic bladder condition that shares many of the same symptoms as endometriosis. While co-existent diagnoses of FBPS and endometriosis have been described in patients presenting with a chief complaint of pelvic pain, the prevalence of endometriosis in patients presenting with a chief complaint of chronic bladder pain has yet to be described. We aim to describe the prevalence of endometriosis in patients who undergo diagnostic laparoscopy after presenting first to urogynecologists with a primary complaint of chronic bladder pain.

Methods: This is a descriptive study involving medical record review of patients with chronic bladder pain who presented to a single urogynecology clinic between May 2021 and March 2024 and who were subsequently referred to Minimally Invasive Gynecologic Surgery (MIGS). Patients with known endometriosis at the time of presentation were excluded. Data was collected from the electronic medical record and stored in an institution-affiliated REDCap database. Patients who underwent diagnostic laparoscopy were divided into those ultimately diagnosed with endometriosis and those who were not found to have endometriosis. Univariable comparison was performed using Fisher’s Exact Test and Mann-Whitney U Test as appropriate.

Results: During the study period, 65 patients met inclusion criteria. Of those, 35.4% (n=23) decided not to pursue diagnostic laparoscopy and were not included in the data analysis. The remaining patient population had a mean age (SD) of 29.67 (7.47) at presentation to urogynecology. Of the patients who opted for surgery, the prevalence of pathology-confirmed endometriosis was 81.0% (n=34). A significantly higher proportion of FBPS patients diagnosed with endometriosis presented with urinary frequency compared to FBPS patients not found to have endometriosis (94.1% vs 62.5%, p < 0.04). FBPS Patients diagnosed with endometriosis also had higher frequencies of irritable bowel syndrome (76.5% vs 62.5%) and fibromyalgia (20.6% vs 12.5%), although these differences were not found to be statistically significant. Conversely, a significantly higher proportion of FBPS patients without co-occurring endometriosis had a history of sexual trauma compared to FBPS patients diagnosed with endometriosis (50.0% vs 5.9%, p < 0.01).

Conclusions: This study found a high prevalence of co-occurring endometriosis among patients with FBPS who underwent diagnostic laparoscopy after presenting first to urogynecology for a primary complaint of chronic bladder pain. Having urinary frequency as part of the symptomatic presentation in FBPS was associated with co-occurring endometriosis, whereas having a history of sexual trauma was associated with a diagnosis of FBPS without co-occurring endometriosis. These two factors should be considered when determining whether to co-screen for endometriosis in patients with a chief complaint of chronic bladder pain.