Urinary bacteria in adult women with urgency urinary incontinence
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Introduction and hypothesis
This study’s aims were to detect and quantify bacterial DNA in the urine of randomized trial participants about to undergo treatment for urinary urgency incontinence (UUI) without clinical evidence of urinary tract infection (UTI) and to determine if the presence of bacterial DNA in baseline urine relates to either baseline urinary symptoms or UTI risk after urinary tract instrumentation.
Women without clinical evidence of baseline UTI were randomized to cystoscopic onabotulinum toxin A injection and oral placebo medication versus cystoscopic placebo injection and active oral medication. Bacterial DNA in participants’ catheterized urine was measured by quantitative polymerase chain reaction (qPCR).
Bacterial DNA was detected in the urine of 38.7 % of participants (60 out of 155). In these 60 qPCR-positive participants, baseline daily UUI episodes were greater than in the 95 qPCR-negative participants (5.71 [±2.60] vs 4.72 [±2.86], p = 0.004). Neither symptom severity by questionnaire nor treatment outcome was associated with qPCR status or with qPCR level in qPCR-positive subjects. In contrast, the presence of urinary bacterial DNA was associated with UTI risk: only 10 % of the qPCR-positive women developed a UTI post-treatment, while 24 % of the qPCR-negative women did so. The median qPCR level for qPCR-positive samples did not differ significantly by UTI status (UTI 2.58 × 105 vs no UTI 1.35 × 105 copies/mL, p = 0.6).
These results may indicate a urinary bacterial contribution to both baseline UUI and the risk of post-treatment UTI.
KeywordsMicrobiome Urinary bacteria Urinary urgency incontinence Urinary tract infection
Supported by grants from The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH Office of Research on Women’s Health (2U01 HD41249, 2U10 HD41250, 2U10 HD41261, 2U10 HD41267, 1U10 HD54136, 1U10 HD54214, 1U10 HD54215, 1U10 HD54241)
Conflicts of interest
The following list of authors has disclosures to report: Holly E. Richter: Astellas Advisory Board, GlaxoSmithKline, Uromedica, IDEO, Pfizer, Xanodyne (Consultant), Astellas and University of California/Pfizer (Research Grant), Warner Chilcott (Education Grant); Joseph Schaffer: Astellas Advisory Board and Speaker; Anthony Visco: Intuitive Surgical; A. J. Wolfe: Astellas Scientific and Medical Affairs, Inc. The following authors have no disclosures to report: Linda Brubaker, Noriko Shibata, Matthew D. Barber, Ingrid Nygaard, Susie Meikle, Dennis Wallace, Charles W. Nager.
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