International Urogynecology Journal

, Volume 27, Issue 5, pp 723–733 | Cite as

Incontinence medication response relates to the female urinary microbiota

  • Krystal J. Thomas-White
  • Evann E. Hilt
  • Cynthia Fok
  • Meghan M. Pearce
  • Elizabeth R. Mueller
  • Stephanie Kliethermes
  • Kristin Jacobs
  • Michael J. Zilliox
  • Cynthia Brincat
  • Travis K. Price
  • Gina Kuffel
  • Paul Schreckenberger
  • Xiaowu Gai
  • Linda Brubaker
  • Alan J. Wolfe
Original Article


Introduction and hypothesis

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. We hypothesized that microbiome/microbiota characteristics would relate to clinically relevant treatment response to UUI medication per os.


Adult women initiating medication treatment orally 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 samples. Women with UUI were given 5 mg solifenacin, with potential dose escalation to 10 mg for inadequate UUI symptom control at 4 weeks. Additional data and urine samples were collected from women with UUI at 4 and 12 weeks. The samples were assessed using 16S ribosomal RNA (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.


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. Nonresponders had a more diverse community that often included bacteria not typically found in responders.


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 to be related to UUI incontinence status and treatment response in this population of adult women.


Urinary incontinence Clinical microbiology Solifenacin 



We kindly thank Mary Tulke RN and Bozena Zemaitaitis for their assistance with participant recruitment and sample collection and Kathleen McKinley MT (ASCP) for her clinical microbiology contributions. We acknowledge and thank the Loyola University Chicago Health Sciences Division’s Office of Informatics and Systems Development for their expertise and for computational resources used in support of this research.


This study was supported by a grant from the Falk Foundation (LU#202567), by NIH grant R21DK097435-01A1, and by Astellas Scientific and Medical Affairs (ASMA) (Wolfe PI) and is registered at as NCT01642277. Loyola University Chicago Stritch School of Medicine’s research computing facility was developed through grant funds awarded by the Department of Health and Human Services as award number 1G20RR030939-01. The following reagent was obtained through BEI Resources, NIAID, NIH as part of the Human Microbiome Project: Genomic DNA from Microbial Mock Community A (Even, Low Concentration), HM-782D. Our funding sources had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript. ASMA was given a courtesy review.

Conflicts of interest

All Authors have completed and submitted ICMJE Form for Disclosure of Potential Conflicts of Interest.

All authors report that this study was funded in part by a grant from Astellas Scientific and Medical Affairs (ASMA).

Alan J. WOLFE, Ph.D. – Scientific Study/Trial: Investigator Initiated Grant from ASMA for certain aspects of this study.

Linda BRUBAKER, MD – Scientific Study/Trial: Grants from NICHD and NIDDK during conduct of a different study. Health Publishing: Personal fees from Up-To-Date.

Elizabeth R. MUELLER, M.D. reports grants from ASMA, during the conduct of the study; grants and personal fees from ASMA, personal fees from Peri-Coach, and personal fees from Allergan, outside the submitted work.

Reprints will not be available.

Supplementary material

192_2015_2847_MOESM1_ESM.docx (159 kb)
ESM 1 (DOCX 159 kb)


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Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  • Krystal J. Thomas-White
    • 1
  • Evann E. Hilt
    • 1
  • Cynthia Fok
    • 2
  • Meghan M. Pearce
    • 1
  • Elizabeth R. Mueller
    • 3
    • 10
  • Stephanie Kliethermes
    • 4
  • Kristin Jacobs
    • 5
  • Michael J. Zilliox
    • 6
  • Cynthia Brincat
    • 3
    • 10
  • Travis K. Price
    • 1
  • Gina Kuffel
    • 7
  • Paul Schreckenberger
    • 8
  • Xiaowu Gai
    • 9
  • Linda Brubaker
    • 3
    • 10
  • Alan J. Wolfe
    • 1
  1. 1.Departments of Microbiology and Immunology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  2. 2.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  3. 3.Departments of Obstetrics & Gynecology and Urology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  4. 4.Departments of Medicine and Public Health Sciences, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  5. 5.Department of Obstetrics & Gynecology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  6. 6.Department of Public Health Sciences, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  7. 7.Center for Biomedical Informatics, Loyola Genomics FacilityLoyola University ChicagoMaywoodUSA
  8. 8.Department of Pathology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  9. 9.Department of Ophthalmology, Harvard Medical SchoolMassachusetts Eye and Ear InfirmaryBostonUSA
  10. 10.Departments of Obstetrics and Gynecology and Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, Stritch School of MedicineLoyola University ChicagoMaywoodUSA

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