Abstract
BackgroundRecent data showed that a six-domain UPOINT is a flexible and responsive new classification system that has the clinical applicability in CP/CPPS. However, the utility of UPOINT algorithm in men in China with CP/CPPS has not been comprehensively studied. For international validation and adoption, we evaluated this clinical phenotype system for a large cohort of Chinese CP/CPPS patients and correlated it with patient symptoms and erectile dysfunction (ED). We also investigated the addition of an ED domain in regard to symptom correlation.MethodsA total of 389 Chinese males with CP/CPPS were prospectively collected and classified in each domain of the UPOINT system. Symptom severity was measured using the NIH-CPSI and IPSS. The erectile function was evaluated using the IIEF-5. Clinically relevant associations were calculated.ResultsThe percentage of patients positive for each domain was 54.0%, 42.1%, 41.9%, 20.8%, 26.7%, and 40.4% for the Urinary, Psychosocial, Organ-specific, Infection, Neurological/systemic, and Tenderness, respectively. There were significant correlations between the number of positive UPOINT domains and total NIH-CPSI (r = 0.706, p<0.001), IPSS (r = 0.682, p<0.001) and IIEF-5 scores (r = 0.631, P = 0.007) in Chinese cohort. Except for patients age, symptom duration was associated with a significantly greater number of positive domains (r = 0.638, P = 0.005). After adding an ED domain to create a modified UPOINT system, the correlation between the number of phenotypic domains and symptom severity was improved (0.706 to 0.844, p<0.001).ConclusionsThe clinical applicability of using UPOINT phenotyping system has been validated in the Chinese patients with CP/CPPS. In our cohort, the number of positive domains was also correlated with ED symptoms and the significant association between the number of UPOINT domains and NIH-CPSI scores was further refined by adding a domain for ED. Our findings presented here support the utility of using ED as a stand-alone item in the UPOINT domain.
Highlights
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common yet poorly understood condition, with significant economic costs and severe impact on the quality of life of diagnosed patients [1,2]
When the total NIHCPSI score was compared for the presence of each phenotypic domain, significantly increased symptom scores were seen in all having positive domains was 21 (5.4%) for 1 domain, 123 (31.6%) for 2 domains, 167 (42.9%) for 3 domains, 51 (13.1%) for 4 domains, 20 (5.1%) for 5 domains, and 7 (1.8%) for 6 domains
UPOINT on Symptoms To evaluate the impact of adding a domain related to erectile dysfunction (ED) on symptom severity, we analyzed the correlation between the number of positive phenotypic domains and the National Institutes of Health (NIH)-CPSI or international prostate symptom score (IPSS) scores in a modified UPOINT system
Summary
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common yet poorly understood condition, with significant economic costs and severe impact on the quality of life of diagnosed patients [1,2]. A population-based survey has shown the prevalence of CP/CPPS-like symptoms to be 4.5% in China [5]. Symptoms of this condition include chronic pain, voiding symptoms, and pelvic, sexual and psychosocial disturbances, among others [6]. In 2009, Shoskes et al [7] developed a 6point clinical phenotyping system called UPOINT to classify patients with CPPS and interstitial cystitis and subsequently direct appropriate therapy. Each domain has been clinically defined, linked to specific mechanisms of symptom production or propagation, and associated with specific therapy. This phenotype is qualitative, with each domain scored as yes or no. We investigated the addition of an ED domain in regard to symptom correlation
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