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Background: The assessment of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in everyday practice and clinical studies relies on National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores for symptom appraisal, inclusion criteria for clinical trials, follow-up, and response evaluation., Objective: We investigated multiple databases of CP/CPPS patients to determine the prevalence and impact of pain locations and types to improve our strategy of individualized phenotypically guided treatment., Design, Setting, and Participants: Four major databases with CPSI scores for nonselected CP/CPPS clinic patients from Canada, Germany, Italy, and the United States., Outcome Measurements and Statistical Analysis: Individual question scores and subtotal and total scores of CPSI were described and correlated with each other. Ordinal regression analysis was performed to define pain severity categories., Results and Limitations: A total of 1563 CP/CPPS patients were included. Perineal pain/discomfort was the most prevalent pain symptom (63%) followed by testicular pain (58%), pain in the pubic area (42%) and penis (32%); reports of pain during ejaculation and voiding were 45% and 43%, respectively. European patients had a significantly higher number of pain localizations and symptoms compared with North American patients (p<0.001). Severity of pain correlated well with frequency of pain (r = 0.645). No specific pain localization/type was associated with more severe pain. Correlation of pain domain with quality of life (QoL) (r = 0.678) was higher than the urinary domain (r = 0.320). Individually, pain severity (r = 0.627) and pain frequency (r = 0.594) correlated better with QoL than pain localization (r = 0.354). Pain severity categories results for NIH-CPSI item 4 (0-10 numerical rating scale for average pain) were mild, 0-3; moderate, 4-6; severe, 7-10; CPSI pain domain (0-21): mild, 0-7; moderate, 8-13; and severe, 14-21., Conclusions: Pain has more impact on QoL than urinary symptoms. Pain severity and frequency are more important than pain localization/type. Cut-off levels for disease severity categories have been identified that will prove valuable in symptom assessment and the development of therapeutic strategies., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Purpose: Patients with chronic prostatitis-chronic pelvic pain syndrome are difficult to treat due to the unknown etiology and complex clinical presentation. Clinical phenotyping may better correlate with multimodal treatment concepts than a current diagnosis. We evaluated a novel clinical phenotyping system in a database of patients with chronic prostatitis-chronic pelvic pain syndrome at 2 European institutions and correlated it with patient symptoms. We also investigated the addition of a sexual dysfunction domain in regard to symptom correlation and system internal consistency., Materials and Methods: We retrospectively classified 937 patients from Milan, Italy, and 290 from Giessen, Germany, with chronic prostatitis-chronic pelvic pain syndrome into a 6-domain phenotyping system, consisting of urinary, psychosocial, organ specific, infection, neurological and muscle tenderness domains, termed UPOINT. Symptom severity was assessed by the National Institutes of Health Chronic Prostatitis Symptom Index and the International Prostate Symptom Score., Results: There was significant correlation between the number of positive UPOINT domains and Chronic Prostatitis Symptom Index/International Prostate Symptom Score symptoms in the total and Italian cohorts but not in the German cohort. After adding a sexual dysfunction domain to create the modified UPOINTS system phenotypic domains also correlated significantly with Chronic Prostatitis Symptom Index symptoms in the German cohort., Conclusions: Consistency of the UPOINT chronic prostatitis-chronic pelvic pain syndrome clinical phenotyping system was generally confirmed by our study and further refined by adding a sexual dysfunction domain. The treatment effect of clinical phenotyping with UPOINT(S) must be extensively evaluated in prospective treatment studies., (Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)