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.

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OBJECTIVE We sought to estimate the number of women who will undergo inpatient and outpatient surgery for stress urinary incontinence (SUI) or pelvic organ prolapse (POP) in the United States from 2010 through 2050. STUDY DESIGN Using the 2007 Nationwide Inpatient Sample and the 2006 National Survey of Ambulatory Surgery, we calculated the rates for inpatient and outpatient SUI and POP surgery. We applied the surgery rates to the US Census Bureau population projections from 2010 through 2050. RESULTS The total number of women who will undergo SUI surgery will increase 47.2% from 210,700 in 2010 to 310,050 in 2050. Similarly, the total number of women who will have surgery for prolapse will increase from 166,000 in 2010 to 245,970 in 2050. CONCLUSION If the surgery rates for pelvic floor disorders remain unchanged, the number of surgeries for urinary incontinence and POP will increase substantially over the next 40 years.

Vaginal cuff dehiscence and evisceration are rare but serious complications of pelvic surgery, specifically hysterectomy. The data on risks of vaginal cuff dehiscence are variable and there is no consensus on how to manage this complication. In our review, we present a summary of the risk factors, presenting symptoms, precipitating events, and management options for patients who present with vaginal cuff dehiscence after pelvic surgery. In addition, we provide a review of the current literature on this important surgical outcome and suggestions for future research on the incidence and prevention of vaginal cuff dehiscence.

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