Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition; however, many of the traditional therapies used in clinical practice fail to show efficacy when subjected to large randomized placebo-controlled trials. This may be because CP/CPPS is a heterogeneous syndrome rather than a specific disease which would explain the failure of “one size fits all” therapy. In order to direct appropriate therapy, we have developed a six-point clinical phenotyping system to evaluate patients with chronic urologic pelvic pain. The clinical domains are urinary symptoms, psychosocial dysfunction, organ-specific findings, infection, neurologic/systemic, and tenderness of muscles, which produces the acronym UPOINT. Each domain is diagnosed clinically and is associated with specific therapies. This approach is simple and has proven effective in our hands for patients even after many years of failed therapies.
Similar content being viewed by others
References
Shoskes DA (2008) Chronic prostatitis/chronic pelvic pain syndrome. Humana Press
Persson BE, Ronquist G (1996) Evidence for a mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion. J Urol 155:958
He L, Wang Y, Long Z, Jiang C (2010) Clinical significance of IL-2, IL-10, and TNF-alpha in prostatic secretion of patients with chronic prostatitis. Urology 75:654
Westesson KE, Shoskes DA (2010) Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat? Curr Urol Rep 11:261
Pontari MA, McNaughton-Collins M, O’leary MP, Calhoun EA, Jang T, Kusek JW, Landis JR, Knauss J, Litwin MS (2005) A case-control study of risk factors in men with chronic pelvic pain syndrome. BJU Int 96:559
Tripp DA, Nickel JC, Wang Y, Litwin MS, McNaughton-Collins M, Landis JR, Alexander RB, Schaeffer AJ, O’Leary MP, Pontari MA, Fowler JEJ, Nyberg LM, Kusek JW (2006) Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome. J Pain 7:697
Cheah PY, Liong ML, Yuen KH, Teh CL, Khor T, Yang JR, Yap HW, Krieger JN (2003) Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized, placebo controlled trial. J Urol 169:592
Nickel JC, Elhilali M, Emberton M, Vallancien G (2006) The beneficial effect of alfuzosin 10 mg once daily in ‘real-life’ practice on lower urinary tract symptoms (LUTS), quality of life and sexual dysfunction in men with LUTS and painful ejaculation. BJU Int 97:1242
Nickel JC, O’Leary MP, Lepor H, Caramelli KE, Thomas H, Hill LA, Hoel GE (2011) Silodosin for men with chronic prostatitis/chronic pelvic pain syndrome: results of a phase II multicenter, double-blind, placebo controlled study. J Urol 186:125
Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O’Leary MP, Pontari MA, McNaughton-Collins M, Shoskes DA, Comiter CV, Datta NS, Fowler JEJ, Nadler RB, Zeitlin SI, Knauss JS, Wang Y, Kusek JW, Nyberg LMJ, Litwin MS (2004) Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med 141:581
Nickel JC, Krieger JN, McNaughton-Collins M, Anderson RU, Pontari M, Shoskes DA, Litwin MS, Alexander RB, White PC, Berger R, Nadler R, O’Leary M, Liong ML, Zeitlin S, Chuai S, Landis JR, Kusek JW, Nyberg LM, Schaeffer AJ (2008) Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. N Engl J Med 359:2663
Shoskes DA (2001) Use of antibiotics in chronic prostatitis syndromes. Can J Urol 8(Suppl 1):24
Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J, Steinhoff G, Brock G, Patrick AB, Flax S, Goldfarb B, Palmer BW, Zadra J (2003) Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology 62:614
Zhao WP, Zhang ZG, Li XD, Yu D, Rui XF, Li GH, Ding GQ (2009) Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA). Braz J Med Biol Res 42:963
Nickel JC, Forrest JB, Tomera K, Hernandez-Graulau J, Moon TD, Schaeffer AJ, Krieger JN, Zeitlin SI, Evans RJ, Lama DJ, Neal DEJ, Sant GR (2005) Pentosan polysulfate sodium therapy for men with chronic pelvic pain syndrome: a multicenter, randomized, placebo controlled study. J Urol 173:1252
Goldmeier D, Madden P, McKenna M, Tamm N (2005) Treatment of category III A prostatitis with zafirlukast: a randomized controlled feasibility study. Int J STD AIDS 16:196
Shoskes DA, Zeitlin SI, Shahed A, Rajfer J (1999) Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology 54:960
Elist J (2006) Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study. Urology 67:60
Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brahler E, Weidner W (2009) A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol 56:544
Pontari MA, Krieger JN, Litwin MS, White PC, Anderson RU, McNaughton-Collins M, Nickel JC, Shoskes DA, Alexander RB, O’Leary M, Zeitlin S, Chuai S, Landis JR, Cen L, Propert KJ, Kusek JW, Nyberg LMJ, Schaeffer AJ (2010) Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med 170:1586
Anderson RU, Wise D, Sawyer T, Glowe P, Orenberg EK (2011) 6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. J Urol 185:1294
FitzGerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, Kotarinos R, Fraser L, Cosby A, Fortman C, Neville C, Badillo S, Odabachian L, Sanfield A, O’Dougherty B, Halle-Podell R, Cen L, Chuai S, Landis JR, Mickelberg K, Barrell T, Kusek JW, Nyberg LM (2009) Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol 182:570
Shoskes DA, Nickel JC, Rackley RR, Pontari MA (2009) Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis 12:177
Shoskes DA, Nickel JC, Dolinga R, Prots D (2009) Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology 73:538
Samplaski MK, Li J, Shoskes DA (2012) Clustering of UPOINT domains and subdomains in men with chronic prostatitis/chronic pelvic pain syndrome and contribution to symptom severity. J Urol 188:1788
Hedelin HH (2009) Evaluation of a modification of the UPOINT clinical phenotype system for the chronic pelvic pain syndrome. Scand J Urol Nephrol 43:373
Magri V, Wagenlehner F, Perletti G, Schneider S, Marras E, Naber KG, Weidner W (2010) Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol 184:2339
Davis SN, Binik YM, Amsel R, Carrier S (2013) Is a sexual dysfunction domain important for quality of life in men with urological chronic pelvic pain syndrome? Signs “UPOINT” to yes. J Urol 189:146
Samplaski MK, Li J, Shoskes DA (2011) Inclusion of erectile domain to UPOINT phenotype does not improve correlation with symptom severity in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 78:653
Shoskes DA, Nickel JC, Kattan MW (2010) Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology 75:1249
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shoskes, D.A., Nickel, J.C. Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system. World J Urol 31, 755–760 (2013). https://doi.org/10.1007/s00345-013-1075-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-013-1075-6