Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2012 Nov;188(5):1788-93. doi: 10.1016/j.juro.2012.07.036. Epub 2012 Sep 19.
The UPOINT (Urinary, Psychosocial, Organ specific, Infection, Neurologic/systemic and Tenderness of skeletal muscle) system characterizes men with chronic prostatitis/chronic pelvic pain syndrome according to 6 domains. Some domains have multiple possible criteria but to our knowledge grouping these criteria have never been validated. Domain clustering may provide clues to the etiology or treatment of individual phenotypes. We examined domain clustering patterns and the contribution of individual domains and subdomains to symptom severity.
We reviewed the records of 220 patients with chronic prostatitis/chronic pelvic pain syndrome. Of the patients 120 were characterized by UPOINT alone and 100 were characterized by subdomain, including urinary (voiding and storage), psychosocial (catastrophizing and depression), organ specific (bladder and prostate), infection (prostate and urethra) and neurologic/systemic. The NIH-CPSI (National Institutes of Health-Chronic Prostatitis Symptom Index) was used to measure symptom severity.
The urinary, psychosocial, infection and neurologic/systemic subdomains had a similar incidence but organ specific-prostate was more common than organ specific-bladder (51% vs 33%). On cluster analysis with multidimensional scaling urinary, organ specific and tenderness clustered together, as did neurologic, infection and psychosocial. Of the subdomains organ specific-prostate and organ specific-bladder diverged but the others clustered together. The domains that significantly contributed to the total NIH-CPSI score were urinary, psychosocial and tenderness. Only psychosocial contributed independently to the quality of life subscore.
UPOINT domain criteria capture a homogeneous group for each domain except organ specific, in which bladder and prostate diverge. Clustering of domains specific to the pelvis (urinary, organ specific and tenderness) vs systemic domains (neurologic, infection and psychosocial) implies 2 patient populations that may differ in pathophysiology and treatment response. The primary drivers of pain in patients with chronic pelvic pain syndrome are pelvic floor tenderness, depression and catastrophizing.
UPOINT（泌尿系统、心理社会、器官特异性、感染、神经/系统和骨骼肌触痛）系统根据 6 个领域对慢性前列腺炎/慢性骨盆疼痛综合征患者进行分类。一些领域有多个可能的标准，但据我们所知，将这些标准分组从未得到过验证。领域聚类可能为个体表型的病因或治疗提供线索。我们检查了领域聚类模式以及各个领域和子领域对症状严重程度的贡献。
我们回顾了 220 例慢性前列腺炎/慢性骨盆疼痛综合征患者的记录。其中 120 例患者仅采用 UPOINT 进行特征描述，100 例患者采用亚域进行特征描述，包括泌尿系统（排尿和储存）、心理社会（灾难化和抑郁）、器官特异性（膀胱和前列腺）、感染（前列腺和尿道）和神经/系统。采用 NIH-CPSI（美国国立卫生研究院慢性前列腺炎症状指数）来衡量症状严重程度。
泌尿系统、心理社会、感染和神经/系统亚域的发病率相似，但器官特异性-前列腺比器官特异性-膀胱更为常见（51%比 33%）。多维标度聚类分析显示，泌尿系统、器官特异性和触痛聚类在一起，神经、感染和心理社会也聚类在一起。在亚域中，器官特异性-前列腺和器官特异性-膀胱分开，但其他亚域聚类在一起。对 NIH-CPSI 总分有显著贡献的领域是泌尿系统、心理社会和触痛。只有心理社会对生活质量亚评分有独立贡献。
除了器官特异性（其中膀胱和前列腺不同）外，UPOINT 域标准为每个域捕获了一个同质组。骨盆特定（泌尿系统、器官特异性和触痛）与全身系统（神经、感染和心理社会）域的聚类表明可能存在两种患者群体，其在病理生理学和治疗反应上可能有所不同。慢性骨盆疼痛综合征患者疼痛的主要驱动因素是骨盆底触痛、抑郁和灾难化。
