Urinary Bacteria in Adult Women With Urgency Urinary Incontinence

Brubaker, Linda; Nager, Charles W.; Richter, Holly E.; Visco, Anthony G.; Nygaard, Ingrid; Barber, Matthew D.; Schaffer, Joseph I.; Meikle, Susan; Wallace, Dennis; Shibata, Noriko; Wolfe, Alan J.

doi:10.1097/01.ogx.0000451483.95359.a8

Cited by 15 publications

(20 citation statements)

References 15 publications

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“…From an early study that sought to describe FUM variability in women seeking UUI treatment, we reported an association between symptom severity and FUM diversity, including the number and identity of detected bacteria. We also observed evidence of a protective relationship between UTI and the pre-treatment FUM after urinary tract instrumentation (19,21). In another study, our group compared the baseline FUM of women with and without symptoms of UUI.…”

Section: The Fum and Uisupporting

confidence: 57%

“…In light of the improved detection and description of the FUM, these common-sense recommendations are likely to require additional nuance, as the symptoms and clinically important tests for UTI are refined. If beneficial members of the FUM protect women against UTI, and there is some preliminary evidence that they do (19,21), then improper use of antibiotics may be detrimental, at least for some individuals. The existence of the FUM also challenges UTI researchers to reassess their results in animal models that were designed with the assumption that the animal's bladder was sterile.…”

Section: The Fum and Utimentioning

confidence: 99%

“…It is not yet known whether this is also true of the FUM. There is little longitudinal information concerning FUM stability, variability, and resilience to bladder therapies, including antibiotic usage, surgery or instrumentation (19,21). We also do not know whether the FUM adjusts to liquid or solid oral intake or to other human behaviors.…”

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confidence: 99%

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The female urinary microbiota, urinary health and common urinary disorders

Brubaker¹,

Wolfe²

2017

Ann. Transl. Med.

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104

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This review provides the clinical context and updated information regarding the female urinary microbiota (FUM), a resident microbial community within the female bladder of many adult women. Microbial communities have variability and distinct characteristics in health, as well as during community disruption (dysbiosis). Information concerning characteristics of the FUM in health and disease is emerging. Sufficient data confirms that the microbes that compose the FUM are not contaminants and are cultivatable under appropriate conditions. Common clinical conditions, including urinary tract infection (UTI) and urgency urinary incontinence (UUI), a common form of urinary incontinence (UI), may be usefully reconsidered to determine the role of the FUM. Knowledge of FUM characteristics may help advance prevention, diagnosis and treatment of these conditions and other common lower urinary disorders in women. The FUM appears related to UTI and UUI in adult women. The specific role of the FUM remains to be clarified and requires significant additional work in describing FUM variability and resilience in health. Unique aspects of the FUM prompt re-evaluation of existing nomenclature to more appropriately define health and disease; the concept of dysbiosis may be useful for understanding the interaction of the FUM with other aspects of lower urinary tract physiology, including urothelial signaling. Clinicians, through their clinical laboratories, can adopt enhanced urine culture techniques that more fully describe the living microbes within the FUM. This additional information may provide clinicians and their patients an opportunity to impact clinical care without antibiotic use, if the FUM can be appropriately modified to improve treatment precision for UTI and UUI.

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Section: The Fum and Uisupporting

confidence: 57%

Section: The Fum and Utimentioning

confidence: 99%

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The female urinary microbiota, urinary health and common urinary disorders

Brubaker¹,

Wolfe²

2017

Ann. Transl. Med.

Self Cite

104

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“…Since the discovery and confirmation of live bacteria in the bladders of adult women (urobiome), there has been growing interest in the relationship between the urobiome and lower urinary tract symptoms (LUTS), including urinary incontinence (UI). 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 .…”

Section: Introductionmentioning

confidence: 99%

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

Price

Hilt

Thomas‐White

et al. 2019

BJOG

101

105

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Objective To characterise the bladder microbiota of continent adult women.Design Cross-sectional study of adult women who contributed catheterised urine samples, completed validated symptom questionnaires, and provided demographic data.Setting US academic medical centre.Population Well-characterised continent adult women.Methods Participants contributed symptoms questionnaires, demographic data, and catheterised urine samples that were analysed by enhanced urine culture methodology and 16S rRNA gene sequencing.Main outcome measures Associations between demographics and microbial community state structures (urotypes, defined by the dominant taxon of each specimen). ResultsThe bladder microbiota (urobiome) of a control group of 224 continent women were characterised, demonstrating variability in terms of urotype. The most common urotype was Lactobacillus (19%), which did not differ with any demographic. In contrast, the Gardnerella (P < 0.001) and Escherichia (P = 0.005) urotypes were more common in younger and older women, respectively.Conclusions For urobiome research, enhanced culture methods and/or DNA sequencing are the preferred techniques for bacterial detection. The interpretation of clinical tests, such as the standard urine culture, should incorporate the knowledge that some women have Gardnerella or Escherichia urotypes without evidence of any clinical disorder. Clinical care strategies should preserve or restore the beneficial effects of the native urobiome, as disruption of that microbial community could result in unintended vulnerability to uropathogen invasion or opportunistic pathogen overgrowth. Longitudinal studies of urobiome responses to therapies should be encouraged.Keywords Bladder health, female bladder, urinary microbiome, urinary microbiota, urobiome.Tweetable abstract In continent adult women bladder microbiome composition differs by age, with relevance for clinical practice.

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“…The way in which these organisms exist and interact with their environment is called the microbiome [4]. Several studies have now identified differences in the bacterial load [5] and species present [6] in urine taken from women with overactive bladder (OAB) compared to healthy controls. The presence of low levels of bacteria in the bladder could be considered as an interesting idiosyncrasy without any consequences but importantly these differences are associated with clinical symptoms and outcomes [7][8].…”

Section: Introductionmentioning

confidence: 99%