Research
Gynecology
The female urinary microbiome in urgency urinary incontinence

https://doi.org/10.1016/j.ajog.2015.07.009Get rights and content

Objective

The purpose of this study was to characterize the urinary microbiota in women who are 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 multisite randomized trial participants who had no clinical evidence of urinary tract infection; 16S ribosomal RNA 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

More than one-half (51.1%; 93/182) of the participants’ urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs 61.3 years old; P = .0007), had a higher body mass index (33.7 vs 30.1 kg/m2; P = .0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs 4.2 episodes; P < .0001), responded better to treatment (decrease in urgency urinary incontinence episodes, –4.4 vs –3.3; P = .0013), and were less likely to experience urinary tract infection (9% vs 27%; P = .0011). In sequence-positive samples, 8 major bacterial clusters were identified; 7 clusters were dominated not only by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also by other taxa (25%). The remaining cluster had no dominant genus (13%).

Conclusion

DNA sequencing confirmed urinary bacterial DNA in many women with urgency urinary incontinence who had no signs of infection. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response, and posttreatment urinary tract infection risk.

Section snippets

Subjects and specimen acquisition

The full methods of the trial and the primary outcome of the ABC trial have been published.1, 5 Briefly, the trial randomly assigned women without neurologic disease with moderate-to-severe UUI, which was defined as having ≥5 episodes of UUI per 3-day period. Participants were anticholinergic drug naïve or previously had used ≤2 anticholinergic medications other than the study drugs. Exclusion criteria included a postvoid residual volume ≥150 mL or previous therapy with oral study medications

Results

Approximately one-half of the urine samples (51.1%, 93/182) were sequence-positive. Table 1 displays demographics and baseline characteristics of participants relative to sequence status; the mean age was 58.5 years, and most participants were white (77%). Sequence-positive subjects were younger (55.8 ± 12.2 vs 61.3 ± 9.0 years; P = .0007), had a higher body mass index (33.7 ± 7.3 vs 30.1 ± 6.6 kg/m2; P = .0009), and had a higher mean number of baseline UUIE (5.7 ± 2.5 vs 4.2 ± 2.1 per day; P <

Principal findings of the study

In adult women with UUI, the composition of the urinary microbiota is identifiable, variable, and related to certain clinical variables of potential importance. Because the female urinary microbiota has been detected only recently,3, 4, 6, 7, 13, 14, 15 an expanded perspective is warranted. The current study demonstrates that the status of the female urinary microbiota (sequence-positive or sequence-negative) can be used to subclassify women with UUI and that sequence-positive women can be

Acknowledgments

We thank the Loyola University Chicago Health Sciences Division’s Office of Informatics and Systems Development (which was developed through grant funds awarded by the Department of Health and Human Services as award number 1G20RR030939-0 1) for their expertise and for the computational resources used in support of this research.

References (18)

  • A.G. Visco et al.

    Anticholinergic versus botulinum toxin A comparison trial for the treatment of bothersome urge urinary incontinence: ABC trial

    Contemp Clin Trials

    (2012)
  • A.G. Visco et al.

    Anticholinergic therapy vs onabotulinumtoxinA for urgency urinary incontinence

    N Engl J Med

    (2012)
  • L. Brubaker et al.

    The new world of the urinary microbiome in women

    Am J Obset Gynecol

    (2015)
  • L. Brubaker et al.

    Urinary bacteria in adult women with urgency urinary incontinence

    Int Urogynecol J

    (2014)
  • A.J. Wolfe et al.

    Evidence of uncultivated bacteria in the adult female bladder

    J Clin Microbiol

    (2012)
  • E.E. Hilt et al.

    Urine is not sterile: Use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder

    J Clin Microbiol

    (2014)
  • M.M. Pearce et al.

    The female urinary microbiome: a comparison of women with and without urgency urinary incontinence

    MBio

    (2014)
  • S. Yuan et al.

    Evaluation of methods for the extraction and purification of DNA from the human microbiome

    PLoS One

    (2012)
  • P.D. Schloss et al.

    Introducing mothur: Open-source, platform-independent, community-supported software for describing and comparing microbial communities

    Appl Environ Microbiol

    (2009)
There are more references available in the full text version of this article.

Cited by (204)

  • Uropathogenic Escherichia coli in urinary tract infections

    2023, Molecular Medical Microbiology, Third Edition
View all citing articles on Scopus

Drs Pearce and Ziiliox contributed equally as first authors.

Supported by grants from the Eunice Kennedy ShriverNational Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women’s Health (Duke: 2-U10-HD04267-12, Loyola: U10-HD054136, UAB: 2-U10-HD041261-11, Utah: U10-HD041250, Cleveland Clinic: 2-U10-HD054215-06, UCSD: 2-U10-HD054214-06, Magee: 1-U10-HD069006-01, UTSW: 2-U10-HD054241-06, Univ. of Michigan: U10-HD41249, Brown University/Womens and Infants Hospital: U10 HD069013, New Mexico: U10 HD069025, Pennsylvania: U10 HD069010, RTI International: U01 HD069031RT: 1-U01-HD069010-01 and the NIH Office of Research on Women’s Health.

The authors report no conflict of interest.

Cite this article as: Pearce MM, Zilliox MJ, Rosenfeld AB, et al. The female urinary microbiome in urgency urinary incontinence. Am J Obstet Gynecol 2015;213:347.e1-11.

View full text