Inclusion of Erectile Domain to UPOINT Phenotype Does Not Improve Correlation With Symptom Severity in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

OBJECTIVE To evaluate the addition of an erectile dysfunction (ED) domain to the UPOINT (Urinary, Psychosocial, Organ-specific, Infection, Neurologic/systemic, and Tenderness) system in our patients. The UPOINT system classifies men with chronic prostatitis/chronic pelvic pain syndrome into 6 domains. The domain number correlates with the symptom severity, and UPOINT-guided therapy has been shown to significantly improve symptoms. This was recently confirmed in a large Italian cohort, but was only true in a German cohort if an ED domain was added (S, resulting in UPOINTS). METHODS A total of 100 recent patients with chronic prostatitis/chronic pelvic pain syndrome were classified using the UPOINT system. An additional S domain was retrospectively added for men with bothersome ED. Symptom severity was assessed using the National Institutes of Health Chronic Prostatitis Symptom Index. RESULTS The S domain was positive in 28% of the patients. A stepwise positive correlation was found between the number of positive UPOINT domains and symptom severity (Pearson r = .27, P = .006). The S domain reduced this correlation (Pearson r = .25, P = .01). ED had no effect on the total Chronic Prostatitis Symptom Index (24.8 vs 24.7) or on the subscores for pain (11.5 vs 11.6) or quality of life (8.8 vs 8.9). On multivariate analysis, the number of UPOINT domains was the strongest predictor of the total Chronic Prostatitis Symptom Index (relative increase 4.1, 95% confidence interval 1.5-6.7, P = .002), a relationship lost with UPOINTS (relative increase 1.0, 95% confidence interval -2.1-4.2, P = .53). CONCLUSION In our patients, ED did not independently affect the chronic pelvic pain syndrome symptom severity or quality of life. Although ED should be elicited and appropriately treated in men with chronic prostatitis/chronic pelvic pain syndrome, our data do not support the utility of using ED as an independent UPOINT domain. UROLOGY 78: 653-658, 2011. (C) 2011 Elsevier Inc.