OBJECTIVES: To characterize the urinary microbiota in women planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection and treatment outcomes.
STUDY DESIGN: Catheterized urine samples were collected from female multi-site randomized trial participants without clinical evidence of urinary tract infection and 16S rRNA gene sequencing was used to dichotomize participants as either DNA sequence-positive or sequence-negative. Associations with demographics, urinary symptoms, urinary tract infection risk, and treatment outcomes were determined. In sequence-positive samples, microbiotas were characterized on the basis of their dominant microorganisms.
RESULTS: Over half [51.1% (93/182)] of the participants' urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs. 61.3, p=0.0007), had a higher body mass index (33.7 vs. 30.1, p=0.0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs. 4.2, p<0.0001), responded better to treatment (decrease in urgency urinary incontinence episodes -4.4 vs. -3.3, p=0.0013) and were less likely to develop urinary tract infection (9% vs. 27%, p=0.0011). In sequence-positive samples, eight major bacterial clusters were identified; seven clusters were dominated by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also other taxa (25%). The remaining cluster had no dominant genus (13%).
CONCLUSIONS: DNA sequencing confirmed urinary bacterial DNA in many women without signs of infection and with urgency urinary incontinence. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response and post-treatment urinary tract infection risk.
Am J Obstet Gynecol. 2015 Jul 22. pii: S0002-9378(15)00745-0. doi: 10.1016/j.ajog.2015.07.009. [Epub ahead of print]
Pearce MM1, Zilliox MJ2, Thomas-White KJ1, Richter HE3, Nager CW4, Visco AG5, Nygaard I6, Barber MD7, Schaffer J8, Moalli P9, Sung VW10, Smith AL11, Rogers R12, Nolen TL13, Wallace D13, Meikle SF14, Gai X2, Wolfe AJ1, Brubaker L15; Pelvic Floor Disorders Network.
1 Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University, Chicago, Illinois, USA.
2 Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University, Chicago, Illinois, USA.
3 Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
4 Department of Reproductive Medicine, UC San Diego Health System, San Diego, California, USA.
5 Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
6 Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA.
7 Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.
8 Department of Obstetrics and Gynecology, University of Texas Southwest, Dallas, Texas, USA.
9 Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
10 Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
11 Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
12 Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, USA.
13 RTI International, Research Triangle Park, NC USA.
14 Contraception and Reproductive Health Branch, Center for Population Research, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
15 Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, Illinois, USA.