Urologic chronic pelvic pain syndrome 3‐year symptom trajectories: the Multidisciplinary Approach to the Study of Chronic Pelvic Pain ( MAPP) Symptom Patterns Study

Catherine S. Bradley, Mengying You, Wensheng Guo, Niloofar Afari, Priyanka Gupta, Karl J. Kreder, John N. Krieger, H. Henry Lai, Susan K. Lutgendorf, Bruce D. Naliboff, Siobhan Sutcliffe, Frank Tu, David Williams, David A. Williams, Tara McWilliams, Larissa V. Rodríguez, J. Richard Landis
In: BJU International · 2025 · vol. 137(2) , pp. 312–322 · doi:10.1111/bju.70087 · PMID:41328479 · W4416903429
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Abstract

OBJECTIVES: To characterise 3-year pelvic pain and urinary symptom trajectories and to identify baseline factors associated with urologic chronic pelvic pain syndrome (UCPPS) improvement. PATIENTS AND METHODS: The Trans-Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Symptom Patterns Study was a multicentre, prospective cohort study of UCPPS, including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. Patients completed four weekly run-in assessments, baseline visit, and quarterly visits up to 3 years, providing clinical and patient-reported data. A functional clustering approach, applied separately to Pelvic Pain Severity (PPS) and Urinary Symptom Severity (USS) longitudinal change scores, was used to generate symptom trajectory clusters dichotomised as Group 0 'improvers' vs Groups 1-3 'non-improvers'. Logistic regression models explored baseline factors associated with improvement and included run-in period average and baseline scores to adjust for regression to the mean effects. RESULTS: A total of 545 patients (66% female) were followed for a median (interquartile range) of 34 (23-35) months. Four trajectory clusters were identified for each of PPS and USS, consistent with moderate improvement (Group 0), slight improvement (Group 1), no change (Group 2), and slight worsening (Group 3). In all, 18% and 19% of patients were in the moderately improved PPS and USS groups, respectively, representing 30% of patients overall. Female sex, better sleep, and less opioid use were associated with PPS improvement (Group 0); younger age and baseline cystoscopic treatment were associated with USS improvement (Group 0). CONCLUSION: In all, 30% of patients with UCPPS demonstrated improvement in pain and/or urinary symptoms over 3 years. Baseline factors associated with improvement may represent markers of a milder or localised phenotype and/or treatment effects.

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chronic_pelvic_paininterstitial_cystitis

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