UPOINT for IC/PBS

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webslave
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UPOINT for IC/PBS

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J Urol. 2009 May 16. [Epub ahead of print]

Clinical Phenotyping of Women With Interstitial Cystitis/Painful Bladder Syndrome: A Key to Classification and Potentially Improved Management.
Nickel JC, Shoskes D, Irvine-Bird K.
Department of Urology, Queen's University at Kingston, Kingston, Ontario, Canada, and the Department of Urology, Cleveland Clinic, Cleveland, Ohio.


PURPOSE: We have proposed a clinical phenotype system (UPOINT) to classify patients with urological pelvic pain to improve the understanding of etiology and guide therapy. We examined the relationship between UPOINT and symptoms in patients with interstitial cystitis/painful bladder syndrome.

MATERIALS AND METHODS: Patients with interstitial cystitis/painful bladder syndrome were classified in each domain of UPOINT, that is urinary, psychosocial, organ specific, infection, neurological/systemic and tenderness. Symptoms were assessed using the Interstitial Cystitis Symptom Index, Pain/Urgency/Frequency score and visual analogue scale for pain/urgency/frequency. Clinically relevant associations were calculated.

RESULTS: The mean age of 100 consecutive patients with interstitial cystitis/painful bladder syndrome was 48 years, median symptom duration was 7 years and median Interstitial Cystitis Symptom Index score was 12.8. The percent positive for each domain was urinary 100%, psychosocial 34%, organ specific 96%, infection 38%, neurological/systemic 45% and tenderness 48%. All patients were included in at least 2 domains, with 2 domains for 13%, 3 domains-35%, 4 domains-34%, 5 domains-13% and 6 domains-5%. The number of domains was associated with greater symptom duration (p = 0.014) but not age. The number of domains was also associated with poorer general interstitial cystitis and pain symptoms (Interstitial Cystitis Symptom Index p = 0.012, pain p = 0.036) but not with frequency or urgency. The psychosocial domain was associated with increased pain, urgency and frequency, while tenderness was associated with increased Interstitial Cystitis Symptom Index score, pain/urgency/frequency score and urgency. The neurological/systemic domain was associated with increased Interstitial Cystitis Symptom Index score while the infection domain was not associated with any increased symptoms.

CONCLUSIONS: The UPOINT phenotyping system can classify patients with interstitial cystitis according to clinically relevant domains. Increased symptom duration leads to a greater number of domains, and domains that function outside of the bladder (psychosocial, neurological, tenderness) predict a significant impact on symptoms. We hypothesize that the UPOINT system can direct multimodal therapy and improve outcomes.

PMID: 19447429 [PubMed - as supplied by publisher]
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Re: UPOINT for IC/PBS

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Scand J Urol Nephrol. 2009 Aug 9:1-4. [Epub ahead of print]

Evaluation of a modification of the UPOINT clinical phenotype system for the chronic pelvic pain syndrome.

Hedelin HH.
Research and Development Centre and Department of Urology, Karnsjukhuset, Skovde, Sweden.


Objective. To evaluate the recently presented six-domain UPOINT phenotype system for the chronic abacterial prostatitis/chronic pelvic pain syndrome (CPPS) and to correlate it with clinically relevant parameters such as ejaculatory pain, pain localization, erectile dysfunction, cold sensitivity and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).

Material and methods. Fifty men with CPPS were classified in each of the six UPOINT domains. A CPPS focused history was obtained and the men were asked to complete the NIH-CPSI, the International Index of Erectile Function (IIEF-5) and the Coping Strategies Questionnaire (CSQ).

Results. The mean age was 46 years (range 26-71 years). The percentage positive for each domain was 26 (52%) for urinary, 18 (36%) for psychosocial, 19 (38%) for organ specific, 19 (38%) for infection, 18 (36%) for neurological/systemic and 16 (32%) for pelvic muscle tenderness. Mean NIH-CPSI was 23+/-7. The number of positive domains and the NIH-CPSI [correlation coefficient (r) = 0.478, p=0.002] and its quality of life section (r=0.432, p=0.003) were linked; there was, however, no correlation between the number of positive domains and IIEF-5, ejaculatory pain, painful micturition, cold sensitivity or pain localization (except for scrotal pain). The link between catastrophizing and NIH-CPSI was marked (r=0.61, p<0.001).

Conclusions. The correlation between the UPOINT score and NIH-CPSI was verified. A weak or lacking correlation with the studied clinical parameters suggests that further development is required before UPOINT can be considered an optimal phenotyping instrument.

PMID: 19670083
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Re: UPOINT for IC/PBS

Post by dshoskes »

I'm delighted to see that others are following the UPOINT classification system and find it worthy of study and I look forward to reading the actual paper. I do find the conclusion a bit bizarre. The idea of a phenotypic classification is to guide therapy, not replace symptom scores. Why would it matter whether number of domains correlated with any one symptom? If pelvic floor tenderness alone can give you ejaculatory pain then of course having a second, third or fourth additional positive domain won't change the fact that you have that pain. Correlation with the CPSI does show that more domains is associated with worse DEGREE of pain and worse QOL. Ultimately the only true measure of validity and efficacy will be whether multimodal therapy guided by the UPOINT system improves outcomes. Six patients away from finishing the followup to that study and results should be ready to submit to the AUA this year.
Daniel Shoskes MD
www.dshoskes.com
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Re: UPOINT for IC/PBS

Post by alprost »

I feel the development of this classification system is definitely a step in the right direction and will ensure treatment is directed towards priority areas for individual patients.

However, a major flaw in the system as it stands at the moment is that patients are evaluated for 'Pelvic floor muscle tenderness'. The system needs to be updated to ensure patients are evaluated for 'myofascial pain syndrome/trigger points' in the relevant muscle groups. Assessing general pelvic floor muscle tenderness, and myofascial trigger points in specific anatomical locations known to be implicated in the symptom profile of CPPS, are 2 completely different entities.

For example, in my own case, I had trigger points in my rectus abdominus which referred/recreated severe bladder neck pain (8 inches away from the trigger point) and urinary urgency when palpated by Tim Sawyer. If it had only been my pelvic floor which had been examined, this would have been missed and my urinary symptoms would not have improved as much as they have.
This is not Medical advice - Consult your Doctor!

Age:39. Age at onset:31. Symptoms prior to treatment: Golf ball in rectum, severe urinary frequency (2-3x/hr; 5-10x/night); weak stream; painful ejaculation; coccygeal pain; tip of penis pain; general pelvic pain on left; testicular pain; supra-pubic pain. Current | Symptoms: Urinary frequency 1x every 2-3 hrs and 1-2 x a night; mild pelvic pain on left hand side (all symptoms still improving!)
Helped by: Trigger point release; avoiding exercise; pelvic floor relaxation; Neurontin decreased bladder sensitivity somewhat. Worsened by: Exercise; frequent ejaculation; ibuprofen irritates bladder. Made no difference: Diet; biofeedback; quercetin; Steroid anti-inflammatories; Elavil.

****UPDATE*** I am now able to sit again at work all day, and can perform moderate aerobic exersise again for the first time in 8 years!!!

Please read:
viewtopic.php?f=37&t=808&p=3954
viewtopic.php?f=7&t=239&p=1158
viewtopic.php?f=37&t=248&p=1214
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Re: UPOINT for IC/PBS

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Published in Urology
Urology. 2010 Apr 2. [Epub ahead of print]
Phenotypically Directed Multimodal Therapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective Study Using UPOINT.

Shoskes DA, Nickel JC, Kattan MW.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; and Queen's University, Kingston, Ontario, Canada.



OBJECTIVES: Large, controlled trials in chronic pelvic pain syndrome (CPPS) have failed due to patient heterogeneity. To phenotype CPPS patients, we developed the UPOINT system with 6 domains (Urinary, Psychosocial, Organ-Specific, Infection, Neurologic/Systemic and Tenderness). In this study, we treated patients with multimodal therapy based on the UPOINT phenotype and measured response after at least 6 months.

METHODS: Patients with CPPS were offered multimodal therapy based on the UPOINT phenotype (eg, Urinary: alpha blocker or antimuscarinic; Organ-specific: quercetin; Tenderness: physical therapy). One hundred patients agreed to therapy and were reexamined after 26 weeks. Primary endpoint was a minimum 6-point drop in NIH-Chronic Prostatitis Symptom Index (CPSI).

RESULTS: Mean age was 46 years, and median symptom duration was 24 months. A median of 3 UPOINT domains were positive, the most common being Organ-specific (70%), Tenderness (64%), and Urinary (59%). With a median 50-week follow-up, 84% had at least a 6-point fall in CPSI. Number of domains and initial CPSI did not predict response. Mean changes (+/- SD) for CPSI subscores were pain 11.5 +/- 3.2 to 6.1 +/- 3.9, urine 4.7 +/- 3.1 to 2.6 +/- 2.0, QOL 9.1 +/- 2.3 to 4.5 +/- 2.8, and total 25.2 +/- 6.1 to 13.2 +/- 7.2 (all P < .0001). No domain predicted outcome; however, quercetin use resulted in a greater CPSI decrease.

CONCLUSIONS: Multimodal therapy using UPOINT leads to significant improvement in symptoms and quality of life. Moreover, a placebo-controlled trial for every therapy combination is not feasible, and results using UPOINT compare favorably with all large trials of monotherapy.

PMID: 20363491 [PubMed - as supplied by publisher]
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Re: UPOINT for IC/PBS

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Nice
Age: ? | Onset Age: ? | Symptoms: ? | Helped By: ? | Worsened By: ?
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Re: UPOINT for IC/PBS

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