International Urogynecology Journal

, Volume 25, Issue 9, pp 1179–1184 | Cite as

Urinary bacteria in adult women with urgency urinary incontinence

  • Linda BrubakerEmail author
  • Charles W. Nager
  • Holly E. Richter
  • Anthony Visco
  • Ingrid Nygaard
  • Matthew D. Barber
  • Joseph Schaffer
  • Susan Meikle
  • Dennis Wallace
  • Noriko Shibata
  • Alan J. Wolfe
Original Article


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.


Microbiome 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.


  1. 1.
    Albo ME, Richter H, Brubaker L, Norton P, Kraus SR, Zimmern PE et al (2007) Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 356(21):2143–2155PubMedCrossRefGoogle Scholar
  2. 2.
    Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT et al (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362(22):2066–2076PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M et al (2012) Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol 50(4):1376–1383PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Siddiqui H, Nederbragt AJ, Lagesen K, Jeansson SL, Jakobsen KS (2011) Assessing diversity of the female urine microbiota by high throughput sequencing of 16S rDNA amplicons. BMC Microbiol 11(1):244PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Fouts D, Pieper R, Szpakowski S, Pohl H, Knoblach S, Suh M et al (2012) Integrated next-generation sequencing of 16S rDNA and metaproteomics differentiate the healthy urine microbiome from asymptomatic bacteriuria in neuropathic bladder associated with spinal cord injury. J Transl Med 10(1):174PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Khasriya R, Sathiananthamoorthy S, Ismail S, Kelsey M, Wilson M, Rohn JL et al (2013) Spectrum of bacterial colonization associated with urothelial cells from patients with chronic lower urinary tract symptoms. J Clin Microbiol 51(7):2054–2062PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Visco AG, Brubaker L, Richter HE, Nygaard I, Paraiso MF, Menefee SA et al (2012) Anticholinergic versus botulinum toxin A comparison trial for the treatment of bothersome urge urinary incontinence: ABC trial. Contemp Clin Trials 33(1):184–196PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Visco AG, Brubaker L, Richter HE, Nygaard I, Paraiso MFR, Menefee SA et al (2012) Anticholinergic therapy vs OnabotulinumtoxinA for urgency urinary incontinence. N Engl J Med 367:1803–1813PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Sanford JP, Favour CB, Mao FH, Harrison JH (1956) Evaluation of the positive urine culture; an approach to the differentiation of significant bacteria from contaminants. Am J Med 20(1):88–93PubMedCrossRefGoogle Scholar
  10. 10.
    Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al (2011) International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 52(5):e103–e120PubMedCrossRefGoogle Scholar
  11. 11.
    Oliver JD (2005) The viable but nonculturable state in bacteria. J Microbiol 43(Spec No):93–100PubMedGoogle Scholar
  12. 12.
    Zoetendal EG, Vaughan EE, de Vos WM (2006) A microbial world within us. Mol Microbiol 59(6):1639–1650PubMedCrossRefGoogle Scholar
  13. 13.
    Human Microbiome Consortium (2012) Structure, function and diversity of the healthy human microbiome. Nature 7402(486):207–214Google Scholar
  14. 14.
    Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R (2009) Bacterial community variation in human body habitats across space and time. Science 326(5960):1694–1697PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Margulies M, Egholm M, Altman WE, Attiya S, Bader JS, Bemben LA et al (2005) Genome sequencing in microfabricated high-density picolitre reactors. Nature 437(7057):376–380PubMedCentralPubMedGoogle Scholar
  16. 16.
    Shendure J, Porreca GJ, Reppas NB, Lin X, McCutcheon JP, Rosenbaum AM et al (2005) Accurate multiplex polony sequencing of an evolved bacterial genome. Science 309(5741):1728–1732PubMedCrossRefGoogle Scholar
  17. 17.
    Bentley DR, Balasubramanian S, Swerdlow HP, Smith GP, Milton J, Brown CG et al (2008) Accurate whole human genome sequencing using reversible terminator chemistry. Nature 456(7218):53–59PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    McKernan KJ, Peckham HE, Costa GL, McLaughlin SF, Fu Y, Tsung EF et al (2009) Sequence and structural variation in a human genome uncovered by short-read, massively parallel ligation sequencing using two-base encoding. Genome Res 19(9):1527–1541PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Drmanac R, Sparks AB, Callow MJ, Halpern AL, Burns NL, Kermani BG et al (2010) Human genome sequencing using unchained base reads on self-assembling DNA nanoarrays. Science 327(5961):78–81PubMedCrossRefGoogle Scholar
  20. 20.
    Nelson DE, Van Der Pol B, Dong Q, Revanna KV, Fan B, Easwaran S et al (2010) Characteristic male urine microbiomes associate with asymptomatic sexually transmitted infection. PLoS One 5(11):e14116PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • Linda Brubaker
    • 1
    Email author
  • Charles W. Nager
    • 2
  • Holly E. Richter
    • 3
  • Anthony Visco
    • 4
  • Ingrid Nygaard
    • 5
  • Matthew D. Barber
    • 6
  • Joseph Schaffer
    • 7
  • Susan Meikle
    • 8
  • Dennis Wallace
    • 9
  • Noriko Shibata
    • 10
  • Alan J. Wolfe
    • 10
  1. 1.Departments of Obstetrics and Gynecology and Urology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  2. 2.Department of Reproductive MedicineUC San Diego Health System, San DiegoSan DiegoUSA
  3. 3.Department of Obstetrics and GynecologyUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Department of Obstetrics and GynecologyDuke University Medical CenterDurhamUSA
  5. 5.Department of Obstetrics and GynecologyUniversity of UtahSalt Lake CityUSA
  6. 6.Obstetrics, Gynecology and Women’s Health Institute, Cleveland ClinicClevelandUSA
  7. 7.Department of Obstetrics and GynecologyUniversity of Texas Southwestern Medical CenterDallasUSA
  8. 8.Gynecologic Health and Disease Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of HealthBethesdaUSA
  9. 9.Health Sciences DivisionResearch Triangle InstituteResearch Triangle ParkUSA
  10. 10.Department of Microbiology and Immunology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA

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