Chronic pelvic pain and lower urinary tract dysfunction are associated with a high prevalence of depression, anxiety, trauma history, and stress-related disorders, with worsening of symptoms in these groups. This review characterizes the mechanisms behind these associations and the benefits of intervention.

Lower urinary tract symptoms that significantly impair quality of life in men may result from benign prostatic hyperplasia, overactive bladder, or a combination of both conditions. The diagnosis of benign prostatic hyperplasia, a voiding dysfunction due to outlet obstruction, can be made with a thorough history and physical examination. A validated questionnaire should be used to make an accurate initial diagnosis and to monitor treatment effect over time. Selective alpha-1 blockers are an appropriate first-line drug choice for most patients; however, 5-alpha reductase inhibitors and phosphodiesterase type 5 inhibitors may also be used, alone or in combination with each other, depending on symptom severity and if alternative treatment options are needed. If medical therapy is ineffective, surgical and interventional procedures aimed at opening the prostatic urethra are available to ameliorate symptoms. Overactive bladder manifests with urinary urgency, frequency, and nocturia with or without incontinence. The diagnosis of this storage dysfunction due to detrusor overactivity can be made with a thorough history, physical examination, urinalysis, and assessment of the residual volume of urine in the bladder after voiding. First-line treatment for overactive bladder includes beta-3 agonists as well as pelvic floor physical therapy and behavioral interventions. If left untreated, benign prostatic hyperplasia and overactive bladder can result in significant social isolation and relationship strain.

Bladder deep endometriosis is an uncommon but clinically significant phenotype of deep infiltrating endometriosis (DIE), and the coexistence of full-thickness detrusor disease with deep myometrial infiltration of the anterior uterine wall is infrequently documented in a stepwise, reproducible surgical format. We describe a case of a 30-year-old nulligravid female with two years of infertility, cyclical pelvic pain since menarche, severe urinary urgency, dysuria, and persistent microscopic haematuria, in whom magnetic resonance imaging demonstrated an hourglass-shaped fibrotic nodule of the anterior compartment with 16 mm involvement of the bladder dome and 18 mm of myometrial infiltration. Notably, preoperative cystoscopic biopsy had been reported as interstitial cystitis, underscoring the well-recognised tendency of superficially sampled detrusor lesions to be misclassified because endometriosis progresses from the serosa towards the mucosa. The patient was treated by a systematic laparoscopic transmural excision and layered reconstruction. The technique is presented as a teaching framework organised around the mastery of avascular pelvic spaces: development of the prevesical (Retzius) and paravesical spaces, restoration of the vesicouterine plane, retroperitoneal identification and lateral mobilisation of both ureters, complete transmural resection of the bladder nodule together with the infiltrated myometrium while preserving the ureteric orifices, and tension-free two-layer closure of the bladder and uterine wall with barbed (self-anchoring) suture, followed by an intravesical methylene-blue test to confirm a watertight repair. The procedure was completed without intraoperative or postoperative complications, with histological confirmation of endometriosis in both the detrusor and the myometrium. At 12 months of follow-up, the patient had complete resolution of urinary and pain symptoms, with all visual analogue scale (VAS) scores reduced to zero and free histological resection margins. We discuss the anatomical rationale, the diagnostic pitfalls, the correlation with infertility, and the available comparative evidence, and we summarise practical, transferable surgical tips intended to make complete excision safe and reproducible for surgeons developing experience in urinary tract endometriosis.

Background Smoking has been linked to several urological conditions, including lower urinary tract symptoms and interstitial cystitis/bladder pain syndrome (IC/BPS). Cigarette and narghile use remains common among young adults in Lebanon. This study assessed the association between current tobacco/nicotine use and pelvic pain and urgency/frequency (PUF)-defined urinary symptom burden among Lebanese students and recent graduates. Methods This cross-sectional analytical study included 476 Lebanese university students and recent graduates aged 18-30 years during the 2019-2020 academic year. Urinary symptoms were assessed using the PUF questionnaire. A PUF score >2 was analyzed as low-threshold PUF screening-positive urinary symptom burden, and a PUF score of >9 was analyzed as higher-threshold PUF screening-positive symptom burden. Smoking exposure was assessed using items adapted from the Global Adult Tobacco Survey. Associations were assessed using chi-square testing, one-way analysis of variance with Welch correction when appropriate, crude prevalence ratios, multivariable logistic regression, and modified Poisson regression with robust error variance, both with current smoking as the primary exposure and adjusting for age, caffeine intake, sex, body mass index, and university type. Results The sample included 237 males (49.8%) and 239 females (50.2%), with a mean age of 23.57 (SD: 3.43) years and a mean body mass index of 24.11 (SD: 3.82) kg/m[2]. Current smokers represented 167 participants (35.1%). Low-threshold PUF screening-positive urinary symptom burden (PUF >2) was present in 137 smokers (82.0%) and 56 non-smokers (18.1%) (χ[2](1) = 183.70, p < 0.001; crude prevalence ratio: 4.53, 95% CI: 3.53-5.80). Higher-threshold PUF screening-positive symptom burden (PUF >9) was present in 67 smokers (40.1%) and 6 non-smokers (1.9%) (χ[2](1) = 121.69, p < 0.001; crude prevalence ratio: 20.66, 95% CI: 9.16-46.62). In adjusted prevalence-ratio models, smoking remained associated with low-threshold PUF screening-positive urinary symptom burden (adjusted PR: 4.43, 95% CI: 3.49-5.63) and higher-threshold PUF screening-positive symptom burden (adjusted PR: 18.12, 95% CI: 8.29-39.64). Daily cigarette/cigar quantity was associated with a higher mean PUF score among 89 users (ANOVA F(3,85) = 10.14, p < 0.001) and with higher PUF >9 prevalence among the same 89 users with daily quantity data (χ[2](3) = 11.38, p = 0.010). Conclusions Current tobacco/nicotine use was strongly associated with higher questionnaire-based PUF screening-positive urinary symptom burden among Lebanese university-aged adults. A dose-response pattern was observed among cigarette/cigar users. Because this was a cross-sectional questionnaire-based study without clinical confirmation, the findings should be interpreted as screening-based associations rather than confirmed clinical diagnoses.