Incontinence medication response relates to the female urinary microbiota

Abstract

Introduction Many adult women have resident urinary bacteria (urinary microbiome/microbiota). In adult women affected by urinary urgency incontinence (UUI), the etiologic and/or therapeutic role of the urinary microbiome/microbiota remains unknown. Hypothesis Microbiome/microbiota characteristics will relate to clinically relevant treatment response to oral UUI medication. Methods Adult women initiating oral medication treatment for UUI and a comparator group of unaffected women were recruited in a tertiary care health care system. All participants provided baseline clinical data and urine. Women with UUI were given 5mg solifenacin with potential dose escalation to 10mg for inadequate UUI symptoms control at 4 weeks. Additional data and urine samples were collected from women with UUI at 4 and 12 weeks. The samples were assessed by 16S rRNA gene sequencing and enhanced quantitative urine culturing. The primary outcome was treatment response as measured by the validated Patient Global Symptom Control (PGSC) questionnaire. Clinically relevant UUI symptom control was defined as a 4 or 5 score on the PGSC. Results The diversity and composition of the urinary microbiome/microbiota of women with and without UUI differed at baseline. Women with UUI had more bacteria and a more diverse microbiome/microbiota. The clinical response to solifenacin in UUI participants was related to baseline microbiome/microbiota, with responders more likely to have fewer bacteria and a less diverse community at baseline. Non-responders had a more diverse community that often included bacteria not typically found in responders. Conclusions Knowledge of an individual’s urinary microbiome/microbiota may help refine UUI treatment. Complementary tools, DNA sequencing and expanded urine culture, provide information about bacteria that appear related to UUI incontinence status and UUI treatment response in this population of adult women.

Urinary Symptoms and Their Associations With Urinary Tract Infections in Urogynecologic Patients

“…This and other emerging knowledge about urinary microbiota may provide information about the absence of good bacteria, as well as the presence (or overabundance) of bad bacteria. In a companion to this study (11), we reported that urine samples from women who did not self-report UTI were likely to be predominated by Lactobacillus, Streptococcus , and Gardnerella , an observation that is consistent with previous reports (8,9,16). In contrast, the urine of women with UTI were more likely to contain traditional uropathogens at the expense of Gardnerella, Streptococcus and Lactobacillus (11), which may be a clue to the composition of healthy microbiota, consistent in part with previous observations (9,16).…”

“…In a companion to this study (11), we reported that urine samples from women who did not self-report UTI were likely to be predominated by Lactobacillus, Streptococcus , and Gardnerella , an observation that is consistent with previous reports (8,9,16). In contrast, the urine of women with UTI were more likely to contain traditional uropathogens at the expense of Gardnerella, Streptococcus and Lactobacillus (11), which may be a clue to the composition of healthy microbiota, consistent in part with previous observations (9,16). Given its beneficial role in the genito-urinary tract (17–20), Lactobacillus in the bladder may prevent UTI or facilitate microbial restoration following UTI treatment.…”

The urinary microbiome in patients with refractory urge incontinence and recurrent urinary tract infection

“…However, careful labial toilet was employed, and catheterisation of patients who were at a high risk of bacterial infection was not ethically feasible as per our local ethics committee. Analysis of non-UTI CSU samples in a separate study [17] demonstrated that the urinary diversity of patients with urge incontinence who do not respond to VESIcare is eight times greater than normal controls. Thus, it is reasonable to assume that MSUs collected in our study are not a gross overestimation of urinary diversity.…”

The Bladder Is Not Sterile: History and Current Discoveries on the Urinary Microbiome

“…A few key things are known. First, the FUM are distinct between overactive bladder (OAB) patients and continent controls [21, 31] (Figure 2). Overall, the OAB cohorts tend to be more diverse by culture and sequencing, and have fewer Lactobacillus -dominant profiles.…”