MP29-16 IMPROVING THE UTILITY OF CLINICAL PHENOTYPING IN INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME: FROM UPOINT TO INPUT

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis II1 Apr 2017MP29-16 IMPROVING THE UTILITY OF CLINICAL PHENOTYPING IN INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME: FROM UPOINT TO INPUT Alice Crane, Jessica Lloyd, and Daniel Shoskes Alice CraneAlice Crane More articles by this author , Jessica LloydJessica Lloyd More articles by this author , and Daniel ShoskesDaniel Shoskes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.928AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The phenotyping system UPOINT has proven effective in classifying patients with Urologic Pelvic Pain Syndromes in a clinically meaningful way and to guide therapy. While highly successful in men with chronic pelvic pain syndrome (CPPS), UPOINT is more limited in patients with Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) since by definition all patients have the Urinary and Organ specific phenotype. Furthermore, AUA guidelines recommend a sequential tiered approach to therapy rather than the multimodal UPOINT scheme. We sought to modify UPOINT to be more practical and efficacious for IC/PBS METHODS We developed a new phenotype by removing the Urinary and Organ specific domains from UPOINT and adding a Hunner's Ulcers (U) domain, since these patients benefit from phenotype specific therapies (fulguration, cyclosporine). This yields “INPUT”: Infection, Neurologic/Systemic, Psychosocial, Ulcers and Tenderness of Muscles. We applied this system retrospectively to our previously validated upointmd.com IC/PBS database. Symptoms were measured by the Genitourinary Pain Index (GUPI) (valid for men and women). The database was searched for patients with complete data to assess the INPUT domains and include GUPI. Men were included if they reported pain relieved by voiding and/or presence of Hunner's ulcers. Groups were compared with ANOVA, Mann-Whitney, t test or Chi squared when appropriate and correlated with Spearman r. RESULTS There were 239 patients, 154 female (64%) with age range 18-79 (mean 41.8). Incidence of domains was Infection 11%, Neurologic/Systemic 51%, Psychosocial 81%, Ulcers 18% and Tenderness 85%. Mean total domains was 2.46 (range 0-5) and 65% had 2 or 3 positive domains while only 5% had none. There was a stepwise increase in GUPI score with increasing number of positive INPUT domains (ANOVA for differences between groups p<0.0001, Correlation by Spearman r=0.355 p<0.0001). Presence of Hunner's ulcers increased mean symptom score (25.7 vs 29.7, p=0.004) and indeed each of the domains significantly increased total GUPI score except for Infection. CONCLUSIONS The INPUT phenotype in IC/PBS appears to replicate the validity and potential clinical utility of UPOINT in CPPS. Patients have a diversity of phenotypes and more positive domains correlate with more severe symptoms. Since 95% of patients have at least 1 positive domain it may benefit patients to receive multimodal therapy up front for these extra domains (eg. pelvic floor physical therapy, fulguration of ulcers) rather than relying on a sequential tiered approach. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e386-e387 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alice Crane More articles by this author Jessica Lloyd More articles by this author Daniel Shoskes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...