Devised by Daniel A. Shoskes, MD
UPOINT is a system to classify patients with chronic pelvic pain syndrome (category III prostatitis, CPPS, interstitial cystitis, painful bladder syndrome) according to 6 clinically defined areas or domains.
It was developed in 2008 by urologist Dr. Daniel Shoskes. It is based on the recognition that patients who suffer from these clinical syndromes often have very different etiologies and respond to different therapies. The hope is that using multimodal therapy guided by the UPOINT phenotype will lead to more effective therapy. The system is flexible so that as new biomarkers and treatments are validated, they can be incorporated. The following is a summary of our hypothesis for the development of the Chronic Pelvic Pain Syndromes. Local injury in the urinary tract may lead to local injury and inflammation, local muscle spasm and ultimately changes in the peripheral and central nervous system that can propagate symptoms even after the initiating injury is long resolved. Clearly patients with only local injury and inflammation can be treated differently from those with a chronic systemic neurologic condition.
The original paper describing the UPOINT system is Shoskes et al, Prostate Cancer Prostatic Dis. 2009;12(2):177-83. A subsequent paper correlated the UPOINT phenotype in men with Chronic Pelvic Pain Syndrome with symptom severity and duration. This study found that more positive domains correlated with worse symptoms and greater symptom duration. Furthermore, pain was most driven by the psychosocial, neurologic/systemic and tenderness domains (Shoskes et al, Urology. 2009 Mar;73(3):538-42). A third paper correlated the UPOINT phenotype with symptom severity in women with a diagnosis of interstitial cystitis (Nickel, Shoskes and Irvine-Bird, Journal of Urology. 2009 Jul;182(1):155-60). Prospective studies on the efficacy of multimodal therapy driven by the UPOINT phenotype are ongoing.
Patients are classified as yes/no for each of the six UPOINT domains. Each domain is associated with therapies that can be helpful for each specific problem. For instance, a man with CPPS who is positive for the Urinary, Organ Specific and Tenderness domains could be treated with an alpha blocker, quercetin and pelvic floor physical therapy. A women with Interstitial Cystitis who is positive for Urinary, Organ Specific, Infection and Neurologic/Systemic might be treated with an anti-muscarinic, dietary restrictions, PPS, an antibiotic (based on culture and sensitivities) and a neuroleptic drug (eg pregabalin). The UPOINT system can also help indicate which therapies are UNLIKELY to be beneficial. For instance, in the absence of positive cultures, the use of antibiotics is no more effective that placebo and should not be used, especially if there is no history of clinical benefit. Similarly, in a man with CPPS who has no voiding symptoms, alpha blockers are unlikely to help. Obviously the list of therapies needs to be tailored to the individual patient's clinical situation and should be modified by past treatment response, allergies, drug interactions and other comorbid conditions.
The treatment of chronic pelvic pain can be difficult and no evidence based algorithms for therapy are validated. Unfortunately, most patients continue to receive antibiotics despite lack of culture evidence for infection. It is hoped that by using the UPOINT system, physicians might be open to considering other diagnostic and treatment approaches such as:
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