More on UPOINT

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dshoskes
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More on UPOINT

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Urology. 2008 Dec 30. [Epub ahead of print]
Clinical Phenotyping of Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Correlation With Symptom Severity.

Shoskes DA, Nickel JC, Dolinga R, Prots D.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.


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.

PMID: 19118880
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Re: More on UPOINT

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The UPOINT system will definitely benefit this field. The UPOINT system requires a much broader focus than on organ-based treatment and will lead to a more highly collaborative approach to treatment (uro will be part of a team that will include Physical Therapists and Psychologists, to name but two other fields). It'll be bloody marvellous to have uros use a systematic multimodal methodology instead of the haphazard and wildly differing unimodal treatments currently offered. Big thumbs up from me! If this gets adopted, it will be a sea change in the treatment paradigm for UCPPS (hopefully IC/PBS too, eventually).
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The full paper is now available from the UCPPS Data Archive website

Look for Clinical Phenotyping of CP/CPPS Patients

I especially like the comment at the end by Prof Berger.

:smile:
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Re: More on UPOINT

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BTW, this concept has been presented by myself and by Curtis Nickel at several meetings (CPPS and IC) and so far it has been met with a lot of enthusiasm (Dr. Anderson is now a proponent). I'm off to Stockholm to the European Urology meeting and to Shanghai in the Fall to see what the rest of the world thinks. Dr. Nickel and I are currently looking prospectively at treatment outcomes using multimodal therapy based upon the UPOINT classification (I have about 49 pts through 6 months and he has a similar number of IC patients).

Incidentally, this was my published response to Dr. Berger's comments (wasn't included in the main pdf of the paper but available through the Clinical Sciences website):

We agree with the reviewer that incorporating a multimodal, phenotypic approach to therapy for CPPS raises several challenges for Urologists, both in the clinic and for designing clinical trials to assess efficacy. These challenges should not prove insurmountable and frankly should be an improvement over the current widespread practice of limited evaluation, empiric therapy not supported (and sometimes contradicted) by evidence, patient dissatisfaction and failed unimodal clinical trials.

Urology is already a highly collaborative specialty in which the appropriate therapy often involves other specialties, whether in oncology (eg. testis cancer), infertility (eg. in vitro fertilization) or renal transplantation. Urologists need not fear that a UPOINT based approach to multimodal therapy will force them become psychologists and physical therapists. It does however mandate a more thorough all though not particularly time consuming evaluation. By simply using a validated symptom score, asking patients whether their condition has made them hopeless/helpless/depressed and palpating beyond the prostate during the rectal exam to assess for pain and spasm elsewhere in the pelvis, the appropriate role of the Urologist in therapy can be determined. Patient care can then be handled solo, in collaboration or by referral, as the phenotype dictates.
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UPOINT is unquestionably a big step forward in this field of medicine. I congratulate you for being the first to join the dots and lead the field of urology forward in this respect.

You deserve much props from your uro homies ! :icon14: :wink:
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Agreed!:thumbup:
I am not a medical doctor. Please fill out your signature (click here) ☼ ☼ My Starter List for new members
I encourage anxiety prone UCPPS people to consider L-Theanine
Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
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J Urol. 2012 Sep 18. pii: S0022-5347(12)04215-2. doi: 10.1016/j.juro.2012.07.036.
Clustering of UPOINT Domains and Subdomains in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Contribution to Symptom Severity.
Samplaski MK, Li J, Shoskes DA.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.


PURPOSE: The UPOINT (Urinary, Psychosocial, Organ specific, Infection, Neurologic/systemic and Tenderness of skeletal muscle) system characterizes men with chronic prostatitis/chronic pelvic pain syndrome according to 6 domains. Some domains have multiple possible criteria but to our knowledge grouping these criteria have never been validated. Domain clustering may provide clues to the etiology or treatment of individual phenotypes. We examined domain clustering patterns and the contribution of individual domains and subdomains to symptom severity.

MATERIALS AND METHODS: We reviewed the records of 220 patients with chronic prostatitis/chronic pelvic pain syndrome. Of the patients 120 were characterized by UPOINT alone and 100 were characterized by subdomain, including urinary (voiding and storage), psychosocial (catastrophizing and depression), organ specific (bladder and prostate), infection (prostate and urethra) and neurologic/systemic. The NIH-CPSI (National Institutes of Health-Chronic Prostatitis Symptom Index) was used to measure symptom severity.

RESULTS: The urinary, psychosocial, infection and neurologic/systemic subdomains had a similar incidence but organ specific-prostate was more common than organ specific-bladder (51% vs 33%). On cluster analysis with multidimensional scaling urinary, organ specific and tenderness clustered together, as did neurologic, infection and psychosocial. Of the subdomains organ specific-prostate and organ specific-bladder diverged but the others clustered together. The domains that significantly contributed to the total NIH-CPSI score were urinary, psychosocial and tenderness. Only psychosocial contributed independently to the quality of life subscore.

CONCLUSIONS: UPOINT domain criteria capture a homogeneous group for each domain except organ specific, in which bladder and prostate diverge. Clustering of domains specific to the pelvis (urinary, organ specific and tenderness) vs systemic domains (neurologic, infection and psychosocial) implies 2 patient populations that may differ in pathophysiology and treatment response. The primary drivers of pain in patients with chronic pelvic pain syndrome are pelvic floor tenderness, depression and catastrophizing.

PMID: 22998916
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Curr Opin Urol. 2013 Nov;23(6):560-564.
Clinical phenotyping of urologic pain patients.
Kartha GK, Kerr H, Shoskes DA.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.


PURPOSE OF REVIEW: Urologic pain conditions such as chronic prostatitis/chronic pelvic pain syndrome, interstitial cystitis/bladder pain syndrome and chronic orchialgia are common, yet diagnosis and treatment are challenging. Current therapies often fail to show efficacy in randomized controlled studies. Lack of efficacy may be due to multifactorial causes and heterogeneity of patient presentation. Efforts have been made to map different phenotypes in patients with urologic pain conditions to tailor more effective therapies. This review will look at current literature on phenotype classification in urologic pain patients and their use in providing effective therapy.

RECENT FINDINGS: There has been validation of the 'UPOINT' system (urinary symptoms, psychosocial dysfunction, organ specific findings, infection, neurologic/systemic and tenderness of muscle) to better categorize male chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis/bladder pain syndrome. Refinement of domain systems and recent cluster analysis has suggested possible central processes involved in urologic pain conditions similar to systemic pain syndromes such as fibromyalgia, chronic fatigue and irritable bowel syndrome.

SUMMARY: Domain characterization of urologic pain conditions via phenotype mapping can be used to better understand causes of chronic pain and hopefully provide more effective, targeted and multimodal therapy.

PMID: 24080805
[PubMed - as supplied by publisher
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