Endometriosis is a common gynecological disorder characterized by the growth of endometrial-like tissue outside the uterine cavity, leading to chronic inflammation, pelvic pain, and infertility. Reliable mouse models are essential for investigating the molecular, hormonal, immune, and environmental mechanisms underlying disease development and progression. Conventional methods for identifying endometriotic lesions often rely on genetically engineered fluorescent reporter mice, which are time-consuming and costly to generate. Here, we present a simple, non-genetic approach to inducing and visualizing endometriosis in mice by ex vivo labeling donor uterine tissue fragments with Cy5.5-doped silica nanoparticles prior to transplantation. The nanoparticles exhibit favorable physicochemical properties, high fluorescence stability, and minimal cytotoxicity, enabling efficient labeling of uterine tissue without compromising experimental procedures. Following intraperitoneal implantation into recipient mice, Cy5.5-labeled endometriotic lesions can be readily distinguished from surrounding host tissues using fluorescence imaging. This protocol provides a reproducible and versatile method for lesion visualization and tracking, facilitating studies of endometriosis pathogenesis and the preclinical evaluation of diagnostic and therapeutic strategies without the need for genetic manipulation.

Endometriosis may rarely present with atypical manifestations that closely mimic intra-abdominal malignancy or severe pelvic sepsis, resulting in significant diagnostic uncertainty. We present two contrasting cases of presumed severe endometriosis with uncommon clinical and radiological presentations. In the first case, a woman in her 30s presented with acute abdominal pain, progressive abdominal distension, and respiratory compromise associated with massive haemorrhagic ascites and markedly elevated cancer antigen 125 levels. Cross-sectional imaging demonstrated extensive deep infiltrative endometriosis with haemoperitoneum and multiple extra-pelvic endometriotic deposits. In the second case, a woman in her 30s presented with a complex adnexal mass, para-aortic lymphadenopathy and inflammatory features initially concerning for tubo-ovarian abscess or underlying malignancy. Following prolonged antibiotic therapy, complete radiological resolution of the adnexal lesion was observed, with subsequent imaging findings considered highly suggestive of an infected endometrioma. These cases emphasise the diverse spectrum of endometriosis presentations, the limitations of non-histological diagnosis and the importance of multidisciplinary assessment, radiological expertise and longitudinal follow-up in complex presentations.

In recent years we have witnessed increasing interest for the role of microbiota in the pathophysiology and management of prostatic diseases. However, there are several aspects to comprehend. Here, we aim to assess the gut microbiota composition and faecal microbiota-derived short-chain fatty acids production (SCFAs) in the pathogenesis of CP/CPPS. All patients with CP/CPPS attending our urology centre, were enrolled in this study, and underwent urological examination, microbiological evaluation, intestinal microbiota analysis and measurement of interleukins in semen. A cohort of subjects who had undergone intestinal microbiota investigation for various reasons but did not exhibit any symptoms of urological disease, was used as control group. Laboratory data from the two groups were analysed in terms of gut microbiota composition and levels of SCFAs. We enrolled 37 patients and 45 controls. In the CP/CPPS patient group, the mean levels of interleukins were: IL-8 934 pg/ml, IL-10 64 pg/ml, IL-6 871 pg/ml. In this patient group, we found higher levels of Bifidobacteriaceae and Bacteroidaceae and lower levels of Prevotella and Lactobacillus with a Firmicutes/Bacteroides mean ratio at 0.27. The control group had a normal Firmicutes/Bacteroides mean ratio (1.6). The two groups showed a significant difference in total SCFAs levels (p = 0.001) and in particular regarding indole-3-propionic acid (p = 0.003) and butyric acid (p < 0.001). A statistically significant correlation was found between the levels of IL-8 and a decreasing SCFAs production (p < 0.001). A difference in gut microbiota between patients with CP/CPPS and controls, together with a reduction in faecal levels of microbiota-derived short-chain fatty acids and decreased IL-8 levels in semen, might be part of the pathophysiological mechanism in CP/CPPS.

Chronic prostatitis/chronic pelvic pain syndrome is a common male genitourinary condition comprising urinary, musculoskeletal, gastrointestinal, and/or psychological concerns with pain as a prominent feature. It is a diagnosis of exclusion. Physicians should use validated patient questionnaires to inventory presenting symptoms and symptom evolution over time. Questionnaires, such as the National Institutes of Health Chronic Prostatitis Symptom Index, can be particularly helpful in monitoring treatment effect on symptoms. Standardized classification systems can prove useful in choosing therapeutic modalities. Treatment should be individualized for each patient and multimodal; it should focus on symptomatic improvement, with a 25% or 6-point reduction in the National Institutes of Health Chronic Prostatitis Symptom Index score being defined as success. Chronic prostatitis/chronic pelvic pain syndrome is a chronic pain condition. Although pharmacologic and nonpharmacologic treatment modalities have variable proven benefit, few are supported by robust evidence. Chronic prostatitis/chronic pelvic pain syndrome does not predispose men to prostate cancer, but it may be associated with male infertility. Physicians should also be alert for its mental health effects on men.

Pudendal nerve entrapment (PNE) within Alcock's canal is an under-recognized cause of chronic pelvic and perineal pain, increasingly conceptualized as a compartment-like syndrome due to sustained neurovascular compression within a confined fascial space. This systematic review evaluates the anatomical, pathophysiological, diagnostic, and therapeutic evidence supporting this hypothesis. A comprehensive literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library from April 2026 to May 1, 2026, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ten studies were included in the final synthesis, comprising observational studies, cadaveric anatomical analyses, imaging-based diagnostic studies, and interventional and surgical outcome studies. Sample sizes ranged from a cadaveric series of 15-20 specimens to clinical cohorts exceeding 200 patients. Evidence consistently demonstrated that repetitive mechanical stress, fascial constriction, and impaired venous drainage within Alcock's canal may lead to ischemic neuropathy and progressive pudendal dysfunction. Diagnostic modalities such as magnetic resonance (MR) neurography, Nantes criteria, and nerve blocks improved clinical identification, while surgical decompression showed variable but often favorable outcomes. However, significant heterogeneity, small sample sizes, and a lack of standardized outcome measures limit definitive conclusions. Overall, current evidence supports a compartment-like pathophysiology, although further prospective validation is required.

Body image disturbance is a commonly experienced psychological impact of endometriosis and other chronic pelvic pain (CPP) conditions (e.g., vulvodynia). This systematic review and meta-analysis of quantitative literature aimed to describe the prevalence of body image concerns in endometriosis and other CPP conditions, and to delineate the psychosocial, demographic, and condition-specific factors associated with body image. Electronic databases (Medline, CINAHL, EMBASE, PsycINFO, Scopus, ProQuest) were searched for CPP studies with body image outcomes. Quality of included studies was assessed following the Cochrane Collaboration Risk of Bias tool and the Risk of Bias Assessment Tool for Nonrandomised Studies. The systematic search yielded 22 relevant studies (N = 7609). A high prevalence of body image disturbance was evident across CPP types. Compared to healthy control groups, the meta-analysis revealed those with CPP had significantly worse body image concerns (g = 0.50, 95% CI [0.30, 0.69], p < .001). Psychosocial factors associated with body image were anxiety, depression, loneliness, sexual dysfunction and distress across the different CPP conditions. Body functionality may be a key outcome to consider in the relationship between condition-specific symptoms (e.g., pain) and body image concerns, demonstrating potential as a target of intervention. The quality of many included studies was limited by their cross-sectional design and minimal use of theory to interpret findings, highlighting the need for better quality research. Future research in CPP conditions is needed that uses validated measures of body image and expands understanding of constructs such as body functionality, that may be highly relevant for chronic pain conditions.

Decidual changes in deep pelvic endometriosis (DPE) are extremely rare. During pregnancy, endometriotic activity and symptoms diminish due to hormonal changes, whereas the endometrial lining undergoes decidualization in response to progesterone. In some cases, a significant hormonal boost can promote the decidualization of endometriotic implants, with endometriomas being the most common sites for such changes. Decidualized endometriosis at sites outside the ovaries is a rarer phenomenon, and the associated imaging features have been studied less. We present a case of non-pregnancy-related decidualization involving multiple sites of DPE. A 33-year-old woman exposed to ovarian stimulation before in vitro fertilization (IVF) presented with chronic pelvic pain and vaginal bleeding. Emergency CT demonstrated irregular solid tissue in the pouch of Douglas and along the bowel loops, raising concern for a neoplastic process. Tumor markers were negative. Transvaginal ultrasound showed a hypoechoic, irregular, hypervascular lesion, and ultrasound-guided biopsy demonstrated decidualized stromal endometriosis. MRI confirmed a solid mass centered in the posterior cul-de-sac with intermediate T2-weighted (W) signal intensity, hemorrhagic foci on fat-suppressed T1W images, marked diffusion restriction, and avid post-contrast enhancement. Similar solid components were also present at multiple pelvic sites, adjacent to DPE implants. Short-interval MRI follow-up showed size reduction; however, due to persistent pain, fertility-sparing surgery was performed, and histology confirmed decidualization of DPE at all sites. This rare case emphasizes that decidualization can also occur on DPE and outside pregnancy, potentially mimicking malignant transformation, highlighting the role of MRI in aiding diagnosis and guiding proper management for these patients.

The purpose of this narrative review is to explain the cellular mechanisms behind chronic pain, the mechanisms behind extracorporeal shockwave therapy, and its efficacy for the treatment of various chronic pain conditions including tendinopathies, greater trochanteric pain, de quervain tenosynovitis, myofascial pain, plantar fasciitis, fibromyalgia, osteoarthritis, fractures, osteonecrosis, bone edema, coccydynia, low back pain, chronic pelvic pain syndrome/chronic prostatitis, ulcers, and carpal tunnel syndrome.