Current Tobacco/Nicotine Use and Pelvic Pain and Urgency/Frequency (PUF)-Defined Urinary Symptom Burden Among Lebanese University-Aged Adults: A Cross-Sectional Study.

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/m². 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%) (χ²(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%) (χ²(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 (χ²(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.