Yasir Iqbal Lone, Haamid Hassan Bhat, Shahnawaz Hussain Siddiqi, Nahid Khan, Amir Iqbal Lone and Annam Qayoom*
Background: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating disease that induces mental stress, lower urinary symptoms, and pelvic pain, therefore resulting in a decline in quality of life. The present diagnosis and treatments still lead to unsatisfactory outcomes, and novel diagnostic and therapeutic modalities are needed
Aim & Objectives: The assessment on improving the utility of clinical phenotyping in interstitial cystitis/painful bladder syndrome.
Methods: This prospective observational study includes the profile of 62 patients in the Department of urology at Super speciality Hospital Srinagar, one of the associated hospitals of government medical college Srinagar. Patients with CPPS were prospectively classified in each domain of our UPOINT system and the symptoms were measured using the Chronic Prostatitis Symptom Index. Statistical analysis was done using IBM SPSS Statistics for Windows from IBM Corp. (released 2020, Version 27.0. Armonk, NY, USA). Categorical variables were shown in the form of frequencies and percentages. Independent t-test was used. All values were discussed at a 5% level of significance (p<0.05).
Results: The percentage of patients positive for the each domain urinary, psychosocial, organ specific, infection, neurologic/systemic, and tenderness domains, respectively was 100%, 69.1%, 100%, 27%, 57.5%, and 29%. Of the 62 patients, 25% 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 (P<0.01). 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. The mean decrease in ICSI was 13±4 points. Significant clinical improvement (>35%-55% decrease in ICSI-29.8 and >50 % decrease in ICSI- 71.3 %) was observed in 91.4 % compared with initial baseline visit. Significant improvement was seen after UPOINT directed treatment with the symptoms of interstitial cystitis/painful bladder syndrome.
Conclusion: Multimodal therapy using UPOINT leads to significant improvement in symptoms and quality of life. CP/CPPS is a heterogeneous condition and, much like with prostate cancer, optimal therapy can only be achieved by classifying patients into clinically meaningful phenotypic groups and letting the phenotype drive therapy.