Bladder Bacterial Diversity Differs In Continent and Incontinent Women: A Cross-Sectional Study

The ability to group women with urinary incontinence (UI) into the appropriate sub-category [e.g., stress urinary incontinence (SUI) or urgency urinary incontinence (UUI)] depends on a combination of symptoms, physical findings and, when available, results of urodynamic testing); these provide evidence of presumed underlying mechanisms. This clinical algorithm is more dichotomous than the likely underlying biology, and many affected women have more than one type of incontinence symptom. New and more precise methods for understanding differences and phenotyping patients are needed. Our group, the Loyola Urinary Education and Research Collaboration (LUEREC) study the human urinary urobiome, including the resident microbes of the bladder. We sought to determine if the urobiome was different between women with UUI and SUI in the hope that these findings could be used as a more precise biomarker for diagnosis.

In this study, we used an enhanced culture method called Expanded Quantitative Urine Culture (EQUC) to assess the bacterial contents of catheterized urine specimens from over 300 adult women with UI (both UUI and SUI) and unaffected controls. We found that women with UI, regardless of subtype, had a higher frequency of detectable bacteria than unaffected controls. We also found similar trends relating to incontinence symptom severity. Surprisingly, however, there were no differences between the UI subtypes.

The differences between affected and unaffected women will require further study to determine whether the urobiome changes are a cause or effect of UI. These findings may provide opportunities that would allow for a more nuanced categorization of women within subcategories of UI or predict treatment efficacy. It is intriguing to consider whether the higher microbial diversity reflects the loss of regulatory mechanisms that maintain a normal microbial community. As urobiome research progresses, urobiome characteristics may be a therapeutic target for UI prevention, diagnosis, and/or treatment.

Written by: Travis K Price, Huaiying Lin, Xiang Gao, Krystal J Thomas-White, Evann E Hilt, Elizabeth R Mueller, Alan J Wolfe, Qunfeng Dong, Linda Brubaker

Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA., Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA., Departments of Obstetrics & Gynecology and Urology, Loyola University Medical Center, Maywood, Illinois, USA., Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA. Electronic address: ., Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA. Electronic address: ., Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, La Jolla, California, USA. Electronic address: .

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