Bacterial Colonization as a Possible Source of Overactive Bladder Symptoms in Pediatric Patients: A Literature Review

Abstract

Overactive Bladder (OAB) is a common condition that is known to have a significant impact on daily activities and quality of life. The pathophysiology of OAB is not completely understood. One of the new hypothetical causative factors of OAB is dysbiosis of an individual urinary microbiome. The major aim of the present review was to identify data supporting the role of bacterial colonization in overactive bladder symptoms in children and adolescents. The second aim of our study was to identify the major gaps in current knowledge and possible areas for future clinical research. There is a growing body of evidence indicating some relationship between qualitative and quantitative characteristics of individual urinary microbiome and OAB symptoms in adult patients. There are no papers directly addressing this issue in children or adolescents. After a detailed analysis of papers relating urinary microbiome to OAB, the authors propose a set of future preclinical and clinical studies which could help to validate the concept in the pediatric population.

The Urinary Microbiome: A Pediatric Urological Perspective

“…(1) UTI: Since the establishment of the standard urine culture in the 1950s until approximately 10 years ago, the UT had been considered sterile under normal conditions [7][8][9][10][11]. This perspective is now altered with the discovery of the genitourinary microbiome and the demonstration that most urinary bacteria identified by 16S sequencing can be cultured under expanded conditions [10,12]. As symptomatic UTI is the outcome of an altered UM makeup, some researchers have suggested that the terms "UTI" and "asymptomatic bacteriuria" be replaced by the term "dysbiosis" [14].…”

“…(2) UUI and OAB: OAB is a poorly understood disorder, but is thought to be multifactorial and is believed to originate from abnormal neuromuscular signaling and functioning of the detrusor muscle [10,22]. In the pediatric population, OAB not only burdens the child's development but also negatively impacts the family [12]. OAB is a condition where frequent urination is required, which often leads to UUI.…”

“…With the advent of modern molecular high throughput DNA sequencing techniques such as 16S ribosomal RNA (rRNA) gene or whole metagenome sequencing, slowly or fastidiously growing aerobic and anaerobic bacteria have been detected as part of a unique commensal flora colonizing the UT [4,12]. Recently, there has been a shift in the outdated concept of sterile urine in healthy individuals, and interest in the role of the urinary microbiome (UM) is growing.…”

“…The Gardnerella-dominant or Lactobacillus-dominant groups expressed rUTI with symptoms in the presence of risk factors such as the degree of Gardnerella proliferation or causative agents of bacterial vaginosis.Depending on other risk factors, the presence of Gardnerella in the urine is considered to be related to rUTI.The majority of UM studies have focused on adult subjects, and pediatric reports are scarce. Mapping the UM in the pediatric population has just begun[12]. Kinneman et al[20] assessed the UM in 85 children younger than 48 months, with and without UTI.…”

Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

“…Dysbiosis of the urobiome has been related to an increased risk of urinary tract infection, nephrolithiasis, and dysfunction of the lower urinary tract [ 9 , 10 , 33 ]. Although most studies focused on adults, the number of investigations evaluating the relationship between the urobiome, dysbiosis, and urinary tract diseases in children increases [ 11 , 24 , 34 , 35 ].…”