Can we predict which patient will fail drug treatment for overactive bladder? A think tank discussion

Νitti, Victor W.; Kopp, Zoë; Lin, Alex T.L.; Moore, Kate H.; Oefelein, Michael G.; Mills, Ian W.

doi:10.1002/nau.20910

Cited by 38 publications

(31 citation statements)

References 47 publications

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“…ϩ Lactobacillus crispatus (6) ϩ ϩ Lactobacillus delbrueckii (1) ϩ ϩ Lactobacillus fermentum (1) ϩ Lactobacillus gasseri (12) ϩ ϩ ϩ ϩ ϩ Lactobacillus iners (6) ϩ ϩ ϩ ϩ Lactobacillus jensenii (10) ϩ ϩ ϩ ϩ Lactobacillus johnsonii (1) ϩ Lactobacillus rhamnosus (2) ϩ ϩ Micrococcus luteus (9) ϩ ϩ ϩ ϩ Micrococcus lylae (1) ϩ ϩ Neisseria perflava (1) ϩ (Continued on following page)…”

Section: Discussionmentioning

confidence: 99%

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Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder

et al. 2014

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Our previous study showed that bacterial genomes can be identified using 16S rRNA sequencing in urine specimens of both symptomatic and asymptomatic patients who are culture negative according to standard urine culture protocols. In the present study, we used a modified culture protocol that included plating larger volumes of urine, incubation under varied atmospheric conditions, and prolonged incubation times to demonstrate that many of the organisms identified in urine by 16S rRNA gene sequencing are, in fact, cultivable using an expanded quantitative urine culture (EQUC) protocol. Sixty-five urine specimens (from 41 patients with overactive bladder and 24 controls) were examined using both the standard and EQUC culture techniques. Fifty-two of the 65 urine samples (80%) grew bacterial species using EQUC, while the majority of these (48/52 [92%]) were reported as no growth at 10 3 CFU/ml by the clinical microbiology laboratory using the standard urine culture protocol. Thirty-five different genera and 85 different species were identified by EQUC. The most prevalent genera isolated were Lactobacillus (15%), followed by Corynebacterium (14.2%), Streptococcus (11.9%), Actinomyces (6.9%), and Staphylococcus (6.9%). Other genera commonly isolated include Aerococcus, Gardnerella, Bifidobacterium, and Actinobaculum. Our current study demonstrates that urine contains communities of living bacteria that comprise a resident female urine microbiota. Overactive bladder (OAB) is a highly prevalent syndrome characterized by urinary urgency with or without urge urinary incontinence and is often associated with frequency and nocturia (1). The etiology of OAB is often unclear and antimuscarinic treatments aimed at relaxing the bladder are ineffective in a large percentage of OAB sufferers, thereby suggesting etiologies outside neuromuscular dysfunction (2). One possibility is that OAB symptoms are influenced by microbes that inhabit the lower urinary tract (urinary microbiota).The microbiota of the female urinary tract has been poorly described; primarily, because a "culture-negative" status has been equated with the dogma that normal urine is sterile. Yet, emerging evidence indicates that the lower urinary tract can have a urinary microbiota (3-8). For example, our group previously reported the use of 16S rRNA gene sequencing to identify bacterial DNA (urinary microbiome) in culture-negative urine specimens collected from women diagnosed with pelvic prolapse and/or urinary incontinence, as well as from urine of women without urinary symptoms (4). Other investigators also have used culture-independent 16S rRNA gene sequencing to obtain evidence of diverse bacteria that are not routinely cultivated by clinical microbiology laboratories in the urine of both women and men (3, 6, 9, 10).Most of our previously sequenced urine specimens underwent standard clinical urine cultures that were reported as "no growth" at a 1:1000 dilution by our diagnostic microbiology laboratory (4). On the basis of this sequence-based evidence, which su...

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Section: Discussionmentioning

confidence: 99%

“…The etiology of OAB is often unclear and antimuscarinic treatments aimed at relaxing the bladder are ineffective in a large percentage of OAB sufferers, thereby suggesting etiologies outside neuromuscular dysfunction (2). One possibility is that OAB symptoms are influenced by microbes that inhabit the lower urinary tract (urinary microbiota).…”

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confidence: 99%

Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder

et al. 2014

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“…For example, urgency urinary incontinence (UUI) is poorly understood chronic urinary condition that is often attributed to abnormal neuromuscular signaling and/or functioning. However, alternative or complementary mechanisms beyond neuromuscular abnormalities must be considered, since UUI pharmacological treatments aimed at the overactive bladder are ineffective in approximately half of the pharmacologically treated UUI population (7, 8). …”

Section: Introductionmentioning

confidence: 99%

The Female Urinary Microbiome: a Comparison of Women with and without Urgency Urinary Incontinence

Pearce

Hilt

Rosenfeld

et al. 2014

mBio

593

772

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Bacterial DNA and live bacteria have been detected in human urine in the absence of clinical infection, challenging the prevailing dogma that urine is normally sterile. Urgency urinary incontinence (UUI) is a poorly understood urinary condition characterized by symptoms that overlap urinary infection, including urinary urgency and increased frequency with urinary incontinence. The recent discovery of the urinary microbiome warrants investigation into whether bacteria contribute to UUI. In this study, we used 16S rRNA gene sequencing to classify bacterial DNA and expanded quantitative urine culture (EQUC) techniques to isolate live bacteria in urine collected by using a transurethral catheter from women with UUI and, in comparison, a cohort without UUI. For these cohorts, we demonstrated that the UUI and non-UUI urinary microbiomes differ by group based on both sequence and culture evidences. Compared to the non-UUI microbiome, sequencing experiments revealed that the UUI microbiome was composed of increased Gardnerella and decreased Lactobacillus. Nine genera (Actinobaculum, Actinomyces, Aerococcus, Arthrobacter, Corynebacterium, Gardnerella, Oligella, Staphylococcus, and Streptococcus) were more frequently cultured from the UUI cohort. Although Lactobacillus was isolated from both cohorts, distinctions existed at the species level, with Lactobacillus gasseri detected more frequently in the UUI cohort and Lactobacillus crispatus most frequently detected in controls. Combined, these data suggest that potentially important differences exist in the urinary microbiomes of women with and without UUI, which have strong implications in prevention, diagnosis, or treatment of UUI.

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“…20,21 To make matters even more complex, a specific definition of refractory OAB has not yet been established, resulting in different initiation time points with other medications or treatment modalities. 22 Canadian urologists and gynecologists generally agree that OAB treatment should be started with the lowest recommended medication dose. Our survey revealed that a slim majority of respondents (52% vs. 45%) recommend OAB pharmacotherapy for a defined time period rather than lifelong.…”

Section: Discussionmentioning

confidence: 99%

How long do we have to treat overactive bladder syndrome? A questionnaire survey of Canadian urologists and gynecologists

Przydacz

Campeau

Walter

et al. 2018

CUAJ

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Introduction: Overactive bladder syndrome (OAB) is a highly prevalent and costly condition worldwide with negative impact on health-related quality of life. Although many guidelines exist and anticholinergics are considered to be the mainstay of pharmacological treatment, data are lacking regarding optimal treatment duration. Therefore, the aim of this study was to determine practice patterns of Canadian urologists and gynecologists regarding duration of OAB pharmacotherapy. Methods: A 14-question survey was designed and survey links (English and French) were sent by email to all practicing urologists and gynecologists registered with the Canadian Urological Association and the Society of Obstetricians and Gynecologists of Canada via the associations' email lists. The SurveyMonkey website served as platform where responses were collected and stored. Results: A total of 301 physicians completed the questionnaire; 250 respondents (83%) prescribe anticholinergics or beta-3-adrenoceptor agonist (mirabegron) in their practice, and 202 (81%) start patient treatment with the lowest recommended medication dose. One hundred and twelve respondents (45% of those who prescribe OAB medications) classified OAB pharmacotherapy as a lifelong management strategy, whereas 130 (52% of those who prescribe OAB medications) think that OAB pharmacotherapy should be administered for a defined time period. Six-month and one-year time periods of drug treatments are the most commonly chosen answers given by physicians who treat their patients for a defined duration. Conclusion: There is general agreement among Canadian urologists and gynecologists that OAB treatment should be started with the lowest recommended medication dose. A slim majority of respondents think that OAB pharmacotherapy should be administered for a defined duration.

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Can we predict which patient will fail drug treatment for overactive bladder? A think tank discussion

Cited by 38 publications

References 47 publications

Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder

Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder

The Female Urinary Microbiome: a Comparison of Women with and without Urgency Urinary Incontinence

How long do we have to treat overactive bladder syndrome? A questionnaire survey of Canadian urologists and gynecologists

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