AUA 2009: UPOINT phenotyping

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(Note: this is an abstract from a conference, not a published study.)

Clinical Phenotyping of Chronic Prostatitis/Chronic Pelvic Pain Syndrome Patients and Correlation with Symptom Severity

Authors: Daniel A Shoskes*, Cleveland, OH; J Curtis Nickel, Kingston, ONCanada; Robert Dolinga, Dona Prots, Cleveland, OH

Introduction and Objective: Category III Chronic Prostatitis, or Chronic Pelvic Pain Syndrome (CPPS) is a heterogeneous syndrome with variable treatment response. We have proposed a clinical phenotype system (UPOINT) to classify patients with urologic pelvic pain to help understand etiology and guide therapy. We wish to validate this system in men with CPPS and to determine whether type and number of domains correlated with symptom severity. Methods: Ninety men with CPPS were retrospectively classified in each domain of the UPOINT system using data from the first clinical visit as follows: Urinary (CPSI urinary score >4), Psychosocial (depression, catastrophizing), Organ Specific (prostate tenderness, inflammation), Infection (localized uropathogens in prostate fluid without urinary tract infection), Neurologic/Systemic (pain outside pelvis, fibromyalgia, irritable bowel disease), Tenderness (pelvic floor spasm or trigger points). Symptom severity was measured by the NIH Chronic Prostatitis Symptom Index (CPSI). Results: Percent of patients positive for each domain was Urinary 52%, Psychosocial 34%, Organ Specific 61%, Infection 16%, Neurologic/Systemic 37% and Tenderness 53%. Twenty-two percent had only one domain and there was a significant stepwise increase in total CPSI score as number of positive domains increased. Symptom duration greater than 2 years was associated with more positive domains (2.9+/-0.21 vs 2.3+/-0.14, p=.01). Comparing total CPSI score with presence of each domain, significantly increased symptoms were seen in patients positive for the urinary, psychosocial, organ specific and neurologic/systemic domains. When this analysis was repeated for the pain subscore, psychosocial, neurologic/systemic and tenderness domains had significantly higher scores. Only psychosocial and neurologic domains influenced quality of life. Conclusions: Applying the UPOINT system to CPPS patients discriminates clinical phenotypes that allows hypothesis testing for etiology and therapy. Number of positive domains correlates with symptom severity and duration of symptoms increases number of domains. Since each domain has specific targeted therapies, we propose that multimodal therapy may best be guided by the UPOINT phenotype.