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Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study
Daniel A Shoskes1, J Curtis Nickel, Michael W Kattan
1Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. dshoskes@mac.com
Urology
|April 6, 2010
Summary
Multimodal therapy guided by the UPOINT system significantly improved chronic pelvic pain syndrome (CPPS) symptoms and quality of life in 84% of patients. This approach offers a viable alternative to large, complex monotherapy trials.
Area of Science:
- Urology
- Pain Management
- Patient Phenotyping
Background:
- Chronic pelvic pain syndrome (CPPS) presents significant challenges due to patient heterogeneity.
- Previous large, controlled trials in CPPS have faced difficulties and failed.
- The UPOINT system was developed to phenotype CPPS patients into six distinct domains.
Purpose of the Study:
- To evaluate the efficacy of multimodal therapy tailored to the UPOINT phenotype in CPPS patients.
- To assess treatment response after a minimum of six months of UPOINT-guided therapy.
Main Methods:
- One hundred CPPS patients received multimodal therapy based on their UPOINT phenotype.
- Therapies included alpha blockers, antimuscarinics, quercetin, and physical therapy.
- Patients were reassessed after 26 weeks, with the primary endpoint being a ≥6-point drop in NIH-CPSI score.
Main Results:
- 84% of patients achieved a ≥6-point reduction in NIH-CPSI score after a median 50-week follow-up.
- Significant improvements were observed in pain, urinary symptoms, quality of life, and total CPSI scores (P<.0001).
- Quercetin use was associated with a greater CPSI decrease, though no single UPOINT domain predicted outcome.
Conclusions:
- UPOINT-guided multimodal therapy demonstrates significant efficacy in improving CPPS symptoms and quality of life.
- Conducting placebo-controlled trials for every therapy combination is impractical.
- UPOINT-based treatment results are favorable compared to large monotherapy trials.