Urologic chronic pelvic pain syndrome: insights from the MAPP Research Network.

Urologic chronic pelvic pain syndrome (UCPPS), which encompasses interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, is characterized by chronic pain in the pelvic region or genitalia that is often accompanied by urinary frequency and urgency. Despite considerable research, no definite aetiological risk factors or effective treatments have been identified. The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network uses a novel integrated strategy to characterize UCPPS as a systemic disorder that potentially involves multiple aetiologies. The first phase, MAPP I, included >1,000 participants who completed an intensive baseline assessment followed by a 12-month observational follow-up period. MAPP I studies showed that UCPPS pain and urinary symptoms co-vary, with only moderate correlation, and should be evaluated separately and that symptom flares are common and can differ considerably in intensity, duration and influence on quality of life. Longitudinal clinical changes in UCPPS correlated with structural and functional brain changes, and many patients experienced global multisensory hypersensitivity. Additionally, UCPPS symptom profiles were distinguishable by biological correlates, such as immune factors. These findings indicate that patients with UCPPS have objective phenotypic abnormalities and distinct biological characteristics, providing a new foundation for the study and clinical management of UCPPS.

Nature reviews. Urology. 2018 Dec 18 [Epub ahead of print]

J Quentin Clemens, Chris Mullins, A Lenore Ackerman, Tamara Bavendam, Adrie van Bokhoven, Benjamin M Ellingson, Steven E Harte, Jason J Kutch, H Henry Lai, Katherine T Martucci, Robert Moldwin, Bruce D Naliboff, Michel A Pontari, Siobhan Sutcliffe, J Richard Landis, MAPP Research Network Study Group

Department of Urology, University of Michigan, Ann Arbor, MI, USA. ., National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA., Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, CA, USA., Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Division of Digestive Diseases, University of California, Los Angeles, CA, USA., Departments of Anesthesiology and Medicine, University of Michigan, Ann Arbor, MI, USA., Division of Urologic Surgery, Department of Surgery, and Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA., Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University, Palo Alto, CA, USA., The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Lake Success, NY, USA., Departments of Medicine, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA, USA., Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA., Division of Public Health Sciences, Department of Surgery, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA., Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.

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