The patient must have appropriate expectations of a procedure or intervention with appropriate informed consent. Appropriate outcome measures must also be considered and these should include measures from several domains that will include a range of pain scores (eg, worst pain, average pain, frequency), emotional measures, behavioral scores, and, where appropriate, more specific questions around sexual activity Inhibitors,research,lifescience,medical and end-organ functional disorders (eg, bowel and urinary dysfunction). This translates into

clinical Stattic cost practice that the patient needs to be treated as a whole and as an individual through an integrated care team approach. Subsequent intervention should be decided in the context of the biopsychosocial model. There is no doubt about the importance of evaluating and treating UCPPS patients as individuals using

a team approach with comprehensive assessments, expectations, and explanations to optimize outcome. [Andrew Paul Baranowski, BSc Hons, MBBS, FRCA, MD, FFPMRCA] Inhibitors,research,lifescience,medical Optimizing Clinical Outcome Clinical outcome for patients suffering from UCPPS and physicians managing it will depend on multiple factors that can best be described by the biopsychosocial rather Inhibitors,research,lifescience,medical than a pure biomedical model of disease. These factors include antecedent premorbid conditions, associated medical conditions, various etiologic mechanisms, and multiple pathogenic

pathways leading to very heterogenous clinical phenotypic presentations. A comprehensive assessment of all these factors, including diagnosis of all possible pain generators (Table 3), allowing a phenotypic classification (UPOINT is recommended; Figure 3) is therefore required prior Inhibitors,research,lifescience,medical to intervention (Table 4 and Figure 3). Patient and physician expectations must be realistic and patient-oriented goals of therapy must be mutually agreed upon. These should include a clinical meaningful amelioration of symptoms, improvement Inhibitors,research,lifescience,medical in QoL and activities, and reduction in the level of disability. This will only be accomplished not by proper diagnosis and phenotyping (sources of pain, associated conditions, impacting factors) and appropriate therapy (treat all pain sources, all associated conditions, and all impacting factors). A multidisciplinary team approach with comprehensive assessment and individually directed therapy will ultimately optimize outcome. Figure 3 UPOINT domains and associated therapies. CPPS, chronic pelvic pain syndrome; IC, interstitial cystitis; PBS, painful bladder syndrome. Table 3 Pain Generators That May Be Operative in Chronic Pelvic Pain Table 4 The Five Steps of UCPPS Management Main Points Urologic Chronic Pelvic Pain Syndromes (UCPPS) are one of the most difficult conditions to manage in urologic practice.