The urinary microbiome in women with mixed urinary incontinence compared to similarly aged controls

Abstract

Introduction & Hypothesis Previous studies have suggested that women with urinary incontinence have an altered urinary microbiome. We hypothesized that the microbiome in women with mixed urinary incontinence (MUI) differed from controls and tested this hypothesis using bacterial gene sequencing techniques. Methods This multicenter study compared the urinary microbiome in women with MUI and similarly aged controls. Catheterized urine samples were obtained; v4–6 regions of the 16S rRNA gene were sequenced to identify bacteria. Bacterial predominance (> 50% of an individual’s genera) was compared between MUI and controls. Bacterial sequences were categorized into “community-types” using Dirichlet multinomial mixture (DMM) methods. Generalized linear mixed models predicted MUI/control status based on clinical characteristics and community-type. Post-hoc analyses were performed in women <51 and ≥51 years. Sample size estimates required 200 samples to detect a 20% difference in Lactobacillus predominance with P<.05. Results Of 212 samples, 97.6% were analyzed (123 MUI/84 controls, mean age 53±11 years). Overall Lactobacillus predominance did not differ between MUI and controls (45/123=36.6% vs. 36/84=42.9%, P=0.36). DMM analyses revealed six community-types; communities differed by age (P=0.001). A High-Lactobacillus (89.2% Lactobacillus) community had a greater proportion of controls (19/84=22.6%, MUI 11/123=8.9%). Overall, bacterial community-types did not differ in MUI and controls. However, post-hoc analysis of women <51 years found that bacterial community-types distinguished MUI from controls (P=0.041); Moderate-Lactobacillus (aOR 7.78, CI 1.85–32.62) and Mixed (aOR 7.10, CI 1.32–38.10) community-types were associated with MUI. Community-types did not differentiate MUI and controls in women ≥51 years (P=0.94). Conclusions Women with MUI and controls did not differ in overall Lactobacillus predominance. In younger women, urinary bacterial community-types differentiated MUI from controls.

The urobiome of continent adult women: a cross‐sectional study

“…Well over half of this cohort of well‐characterised continent adult women exhibited a detectable urobiome, most commonly of the Lactobacillus urotype. This is consistent with other studies that have shown that Lactobacillus is common in the bladders of adult women with and without lower urinary symptoms . It is not surprising that Lactobacillus predominates the urobiome of many adult women, given the beneficial role that Lactobacillus generally plays in other microbial niches, and the evidence that certain Lactobacillus species are associated with a lack of lower urinary tract symptoms and reduce the risk of post‐surgical UTI , .…”

“…The variability of the urobiome, in terms of urotype, has been reported previously . The most common urotype, Lactobacillus , did not show strong correlations with specific demographic features, including age, menopausal status, parity, and vaginal intercourse.…”

“…Prior to the discovery of the urobiome, the term ‘asymptomatic bacteriuria’ was broadly applied to such patients; however, the utility of this term is being reconsidered in order to avoid inappropriate antibiotic use and to optimise antibiotic stewardship . Although Gardnerella urotypes have been reported in the adult female bladder, this is the first report indicating that the Gardnerella urotype is common in young but not older women. Note that none of these women had symptoms of bacterial vaginosis.…”

“…Prior reports of studies that analysed urine samples obtained from the urinary bladder by transurethral catheterisation suggest a difference in urobiome characteristics between women with urge urinary incontinence (UUI) and a control group of unaffected continent women . Recently, Komesu and co‐workers reported on the urobiome, analysing catheterised urine samples obtained from a well‐described cohort of 84 adult women with only slight or no urinary incontinence and significant overactive bladder symptoms . No comprehensive analysis of continent women has been reported, however, and thus many parameters of the ‘normal’ urobiome are not known and the urobiome characteristics of continent women remains incompletely understood, limiting insights into the relationship between bladder health and LUTS.…”

From bacteriuria to the urinary tract microbiome: the evolution of the views of researchers and clinicians

“…В настоящее время ведутся очень активно исследования микробиома мочевых путей, поскольку они должны помочь в понимании глубоких механизмов взаимодействия микро-и макроорганизма и, как следствие, в разработке новых, более точных диагностических критериев и эффективных методов терапии ИМП. Несмотря на то что большое количество исследований посвящено изучению микробиома мочевого пузыря [6,7], а верхние мочевые пути в данном направлении пока не изучены в связи с очевидными техническими сложностями, практически не вызывает сомнения тот факт, что микроорганизмы присутствуют в мочевых путях на всем их протяжении.…”