Department of Urology, Queen's University at Kingston, Kingston, Ontario, Canada.
J Urol. 2009 Jul;182(1):155-60. doi: 10.1016/j.juro.2009.02.122. Epub 2009 May 17.
We have proposed a clinical phenotype system (UPOINT) to classify patients with urological pelvic pain to improve the understanding of etiology and guide therapy. We examined the relationship between UPOINT and symptoms in patients with interstitial cystitis/painful bladder syndrome.
Patients with interstitial cystitis/painful bladder syndrome were classified in each domain of UPOINT, that is urinary, psychosocial, organ specific, infection, neurological/systemic and tenderness. Symptoms were assessed using the Interstitial Cystitis Symptom Index, Pain/Urgency/Frequency score and visual analogue scale for pain/urgency/frequency. Clinically relevant associations were calculated.
The mean age of 100 consecutive patients with interstitial cystitis/painful bladder syndrome was 48 years, median symptom duration was 7 years and median Interstitial Cystitis Symptom Index score was 12.8. The percent positive for each domain was urinary 100%, psychosocial 34%, organ specific 96%, infection 38%, neurological/systemic 45% and tenderness 48%. All patients were included in at least 2 domains, with 2 domains for 13%, 3 domains--35%, 4 domains--34%, 5 domains--13% and 6 domains--5%. The number of domains was associated with greater symptom duration (p = 0.014) but not age. The number of domains was also associated with poorer general interstitial cystitis and pain symptoms (Interstitial Cystitis Symptom Index p = 0.012, pain p = 0.036) but not with frequency or urgency. The psychosocial domain was associated with increased pain, urgency and frequency, while tenderness was associated with increased Interstitial Cystitis Symptom Index score, pain/urgency/frequency score and urgency. The neurological/systemic domain was associated with increased Interstitial Cystitis Symptom Index score while the infection domain was not associated with any increased symptoms.
The UPOINT phenotyping system can classify patients with interstitial cystitis according to clinically relevant domains. Increased symptom duration leads to a greater number of domains, and domains that function outside of the bladder (psychosocial, neurological, tenderness) predict a significant impact on symptoms. We hypothesize that the UPOINT system can direct multimodal therapy and improve outcomes.
我们提出了一种临床表型系统（UPOINT），用于对泌尿外科盆腔疼痛患者进行分类，以提高对病因的认识并指导治疗。我们研究了 UPOINT 与间质性膀胱炎/膀胱疼痛综合征患者症状之间的关系。
将间质性膀胱炎/膀胱疼痛综合征患者归入 UPOINT 的每个领域，即泌尿系统、心理社会、器官特异性、感染、神经/系统性和压痛。使用间质性膀胱炎症状指数、疼痛/急迫/频率评分和疼痛/急迫/频率视觉模拟量表评估症状。计算临床相关关联。
100 例连续间质性膀胱炎/膀胱疼痛综合征患者的平均年龄为 48 岁，中位症状持续时间为 7 年，中位间质性膀胱炎症状指数评分为 12.8。每个领域阳性的百分比为 100%泌尿系统、34%心理社会、96%器官特异性、38%感染、45%神经/系统性和 48%压痛。所有患者均至少归入 2 个领域，2 个领域占 13%，3 个领域占 35%，4 个领域占 34%，5 个领域占 13%，6 个领域占 5%。领域数量与更长的症状持续时间相关（p=0.014），但与年龄无关。领域数量也与更差的一般间质性膀胱炎和疼痛症状相关（间质性膀胱炎症状指数 p=0.012，疼痛 p=0.036），但与频率或急迫性无关。心理社会领域与疼痛、急迫性和频率增加相关，而压痛与间质性膀胱炎症状指数评分、疼痛/急迫性/频率评分和急迫性增加相关。神经/系统性领域与间质性膀胱炎症状指数评分增加相关，而感染领域与任何症状增加均无关。
UPOINT 表型系统可根据临床相关领域对间质性膀胱炎患者进行分类。症状持续时间的延长导致更多的领域，而膀胱外（心理社会、神经、压痛）功能的领域预测对症状有显著影响。我们假设 UPOINT 系统可以指导多模式治疗并改善结局。
