Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes

Abstract

The urologic chronic pain conditions such as chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis are syndromes whose evaluation and management are controversial. Part of the difficulty in diagnosis and therapy is the heterogeneity of etiologies and symptoms. We propose a six-domain phenotype, which can classify these patients clinically and can direct the selection of therapy in the most evidence based multimodal manner. The domains are urinary, psychosocial, organ specific, infection, neurologic and tenderness of skeletal muscles. This system is flexible and responsive to new biomarkers and therapies as their utility and efficacy are proven.

Recent trend of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) management

“…Clinical six areas include urinary symptoms, psychosocial dysfunction, organspecific findings, infection, neurologic/systemic, and tenderness of muscles and it was named as UPOINT [7].…”

“…Shoskes et al well outlined the UPOINT classification [7]. The categories are composed of urinary, psychosocial, organ specific, infection, neurologic, and skeletal muscle tenderness.…”

The inflammatory journey of a prostatitis patient

“…The 'UPOINT' system classification (urinary, psychosocial, organspecific, infection, neurologic/systemic, tenderness of skeletal muscles) offers a holistic approach to the treatment of the CP/CPPS patient. 13 Dividing patients into clinically relevant phenotypes, its aim is to increase the successful management of bladder and prostate syndromes through greater understanding and reflection. UPOINT enables the practitioner to diagnose and classify CP/CPPS syndromes and develop a tailored, multimodal treatment plan.…”

“…Initial studies suggest that the multimodal treatment guided by UPOINT leads to a significant improvement of symptoms and quality of life. 13 It has been suggested that adding a domain for sexual dysfunction (assessment of erectile and orgasmic dysfunction, impaired sexual desire and intercourse satisfaction/UPOINTS) could further enhance the classification system. 14 …”

What is BPS and how should it be managed in real life clinical practice?

“…Many of these patients are not a homogenous group, but present with various but identifiable clinical phenotypes that predict different responses to different therapies. We have addressed this issue by describing the UPOINT (urinary, psychosocial, organ-specific, infection, neurologic/systemic, and tenderness domains) phenotypic classification system for patients with chronic urologic pain syndromes, 5 including IC/PBS/ BPS, 6 that differentiates patients according to their clinical phenotype, allowing individually directed therapy according to the various phenotype classifications diagnosed. Multimodal therapy is the key to better management of this condition, no matter whether you call it IC, PBS or BPS.…”