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New IC/BPS Phenotyping System Proposed – From UPOINT to INPUT

The UPOINT System for the Clinical Phenotyping of Chronic Pelvic Pain by Nickel, Shoskes and Racily was the first proposed subtyping system for chronic pelvic and bladder pain. It asked physicians to look at and beyond the bladder in six different areas, including:

  • what urinary symptoms are present?
  • what’s the condition of the bladder (i.e. Hunner’s lesions)?
  • does the patient have other related conditions (i.e. IBS)?
  • what is the health of the pelvic floor muscles?
  • does the patient struggle with anxiety / depression?
  • has any infection been found?

Based upon the answers to these questions, they urged doctors to create a custom treatment plan for each patient. This “whole body” approach has been validated in multiple research studies and serves as the foundation for the Canada Urology Associations Guidelines For IC/BPS that were released in 2016.

UPOINT has been remarkably helpful when assessing the chronic prostatitis population however for IC, it has key limits because most IC patients have some degree of bladder symptoms and bladder wall dysfunction. Original co-author Dan Shoskes and colleagues have adapted these guidelines to create a new system for use specifically with IC, called INPUT. This asks physicians to assess five distinct areas:

  • I – Is any infection present?
  • N – Does the patient also have any other neurologic or systemic conditions
  • P – Does the patient have any anxiety / depression or other psychosocial issues?
  • U – Does the patient have Hunner’s ulcers (now known as lesions)
  • T – Does the patient have tight or dysfunctional pelvic floor muscles.

They tested this system with 239 men and women. The incidence of domains was Infection 11%, Neurologic/Systemic 51%, Psychosocial 81%, Ulcers 18% and Tenderness 85%. Patients had, on average, 2.46 domains and 65% had 2 or 3 positive domains. Only 5% had none. The greater the number of domains, the great the symptoms. Hunners lesions increased symptom scores.  They conclude that the INPUT system replicates the validity and clinical utility of the UPOINT system. They also believe that patients may benefit from multimodal therapy up front for each extra domain rather than relying on the sequential tiered approach found in the AUA Guidelines.

There will, undoubtedly, be many proposed subtyping systems in the years to come both at the clinical level and also at the pathological level as they study biopsy samples. I find that the 5 subtypes proposed by Christopher Payne MD in 2015 to be remarkably useful in the education of patients however it does not offer the same validity testing that the UPOINT and INPUT system has. Payne proposed five subtypes:

  • Hunner’s lesions
  • Bladder Wall Driven
  • Pelvic Floor Driven
  • Pudendal Neuralgia
  • Functional Somatic Syndrome / Central Sensitization


Both systems have good points thus we have to look at what they have omitted to determine their value. Neither the UPOINT or the INPUT system consider the role of pudendal nerve entrapment or pudendal neuralgia. It also has some naming challenges in that Hunner’s ulcers are now called Hunner’s lesions. In contrast, the Payne system doesn’t evaluate for anxiety or depression which is clearly important for assessing that patients overall health and quality of life. I can foresee a proposal which blends the best of both!




By |2017-08-16T21:54:00+00:00August 10th, 2017|Interstitial Cystitis Network Blog, Research|Comments Off on New IC/BPS Phenotyping System Proposed – From UPOINT to INPUT

About the Author:

My Google Profile+ Jill Heidi Osborne is the president and founder of the Interstitial Cystitis Network, a health education company dedicated to interstitial cystitis, bladder pain syndrome and other pelvic pain disorders. As the editor and lead author of the ICN and the IC Optimist magazine, Jill is proud of the academic recognition that her website has achieved. The University of London rated the ICN as the top IC website for accuracy, credibility, readability and quality. (Int Urogynecol J - April 2013). Harvard Medical School rated both Medscape and the ICN as the top two websites dedicated to IC. (Urology - Sept 11). Jill currently serves on the Congressionally Directed Medical Research Panel (US Army) where she collaborates with researchers to evaluate new IC research studies for possible funding. Jill has conducted and/or collaborates on a variety of IC research studies on new therapeutics, pain care, sexuality, the use of medical marijuana, menopause and the cost of treatments, shining a light on issues that influence patient quality of life. An IC support group leader and national spokesperson for the past 20 years, she has represented the IC community on radio, TV shows, at medical conferences. She has written hundreds of articles on IC and its related conditions. With a Bachelors Degree in Pharmacology and a Masters in Psychology, Jill was named Presidential Management Intern (aka Fellowship) while in graduate school. (She was unable to earn her PhD due to the onset of her IC.) She spends the majority of her time providing WELLNESS COACHING for patients in need and developing new, internet based educational and support tools for IC patients, including the “Living with IC” video series currently on YouTube and the ICN Food List smartphone app! Jill was diagnosed with IC at the age of 32 but first showed symptoms at the age of 12.