Endometriosis and Lower Urinary Tract Symptoms: Predominance of Overactive Bladder Symptoms and Association with Urethral Mobility and Ultrasonographic Parameters

Background: Endometriosis is a chronic inflammatory disease commonly associated with pelvic pain and infertility. Increasing evidence suggests that women with endometriosis may also experience lower urinary tract symptoms (LUTS), even without direct urinary tract involvement. Aim: This study aimed to evaluate LUTS in women with endometriosis and determine whether these symptoms are associated with urethral ultrasonographic parameters or the localization of endometriotic lesions. Materials and Methods: This prospective case–control study included 166 women aged 17–49 years: 83 with confirmed endometriosis and 83 controls without endometriosis. Endometriosis was confirmed laparoscopically, except in patients with cesarean scar endometriosis, where diagnosis was based on imaging and histopathological confirmation. Clinical assessment included standardized questionnaires and transvaginal pelvic floor sonography. Urinary symptoms were assessed using the Urogenital Distress Inventory short form (UDI-6). Urethral length and mobility were evaluated at rest, during contraction, and during the Valsalva maneuver. Results: Women with endometriosis demonstrated significantly higher total UDI scores than controls (27.8 vs. 16.7; p = 0.002), with the greatest differences in pain/discomfort and urine leakage symptoms. No significant differences in urethral anatomy were observed. Among symptomatic patients, urethral mobility during Valsalva was significantly lower in the endometriosis group (p = 0.041). Lesion localization was not associated with symptom severity. Conclusions: Women with endometriosis experience a greater burden of LUTS, particularly bladder storage dysfunction and pain, likely related to functional and neuroinflammatory mechanisms rather than structural abnormalities.