ABSTRACT
Psychological factors may play a role in the pathophysiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This case series describes a cohort of 10 men presenting with CP/CPPS whose symptoms began after an extramarital sexual encounter, who strongly believed they had a sexually transmitted infection (STI) despite negative testing, and who have had no improvement with empiric antibiotic treatment. Patients' clinical presentation and physical exam findings are reviewed. All men were clinically phenotyped with the UPOINT system. Pelvic floor spasm and not infection was prominent in these men. Treatment recommendations are proposed and compliance assessed.
Subject(s)
Pelvic Floor Disorders/physiopathology , Pelvic Pain/psychology , Prostatitis/psychology , Sexually Transmitted Diseases/psychology , Spasm/physiopathology , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Chronic Pain , Humans , Male , Pelvic Floor Disorders/psychology , Pelvic Pain/diagnosis , Pelvic Pain/physiopathology , Prostatitis/diagnosis , Prostatitis/physiopathology , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/drug therapy , Spasm/psychology , SyndromeABSTRACT
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.
