Elsevier

Urology

Volume 73, Issue 3, March 2009, Pages 538-542
Urology

Prostatic Diseases and Male Voiding Dysfunction
Clinical Phenotyping of Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Correlation With Symptom Severity

https://doi.org/10.1016/j.urology.2008.09.074Get rights and content

Objectives

To propose a clinical phenotype system (urinary, psychosocial, organ specific, infection, neurologic/systemic, and tenderness [UPOINT]) to classify patients with urologic pelvic pain to help understand the etiology and guide therapy. We wished to validate this system in men with chronic pelvic pain syndrome (CPPS). CPPS is a heterogeneous syndrome with a variable treatment response.

Methods

A total of 90 men with CPPS were retrospectively classified in each domain of our UPOINT system and the symptoms were measured using the Chronic Prostatitis Symptom Index.

Results

The percentage of patients positive for each domain was 52%, 34%, 61%, 16%, 37%, and 53% for the urinary, psychosocial, organ specific, infection, neurologic/systemic, and tenderness domains, respectively. Of the 90 patients, 22% were positive for only 1 domain, and a significant stepwise increase was found in the total Chronic Prostatitis Symptom Index score as the number of positive domains increased. A symptom duration of >2 years was associated with an increase in positive domains (2.9 ± 0.21 vs 2.3 ± 0.14, P = .01). Comparing the total Chronic Prostatitis Symptom Index score with the presence of each domain revealed significantly increased symptoms in patients positive for the urinary, psychosocial, organ specific, and neurologic/systemic domains. When this analysis was repeated for the pain subscore, the psychosocial, neurologic/systemic, and tenderness domains had significantly greater scores. Only the psychosocial and neurologic domains influenced the patients' quality of life.

Conclusions

Applying the UPOINT system to patients with CPPS can discriminate clinical phenotypes, allowing for hypothesis testing for etiology and therapy. The number of positive domains correlated with symptom severity and a longer duration of symptoms increased the number of positive domains. Because each domain has specific targeted therapies, we propose that multimodal therapy might best be guided by the UPOINT phenotype.

Section snippets

Material and Methods

We reviewed the clinical records of 90 new patients with a diagnosis of CPPS seen at the Cleveland Clinic by 1 physician (D.A.S.) and whose information had been recorded in an institutional review board-approved database. Each patient had had their symptom severity measured using the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI),4 reported as subscores for pain, urinary, and quality of life, as well as the total score. A review of the history, physical examination

Results

The mean patient age in this cohort was 44.3 years (range 21-71), with a median duration of symptoms of 30 months (range 3-444). The patients had CPSI scores typical of those reported by us in previous clinical studies: pain 10.8 ± 3.8 (range 0-20), urinary 4.4 ± 3.1 (range 0-10), quality of life 8.5 ± 2.6 (range 2-12), and total 23.7 ± 7.3 (range 6-42). The number of patients with positive findings for each domain was 47 (52%), 31 (34%), 55 (61%), 14 (16%), 33 (37%), and 48 (53%) for the

Comment

Patients with urologic chronic pelvic pain syndromes, including CPPS and interstitial cystitis, are a heterogeneous mix that share clinical features defined by their syndromes but have diverse etiologies and different responses to therapies. Currently, no biomarkers have been validated to help guide classification and treatment. In response to this, we have proposed a clinical phenotype classification in an attempt to better stratify patients with urologic CPPS according to the likely etiologic

Cited by (0)

D. Shoskes is a paid consultant to Farr Labs and a stock holder in Triurol; J. C. Nickel has received grants/research support/scientific study from GlaxoSmithKlein, Merck, Ortho-McNeil, Stellar, Watson Pharmacueticals, Allergan, American Medical Systems, and Pfizer and is a consultant to Farr Laboratories, Merck-Frosst Canada, Ortho-McNeil, Glaxo-Smith-Kline, Triton Pharma, and Watson.

View full text