JOURNAL ARTICLE
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Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity.

Urology 2009 March
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.

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