International Urogynecology Journal

, Volume 29, Issue 12, pp 1765–1771 | Cite as

Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients

  • Cynthia S. Fok
  • Xiang Gao
  • Huaiying Lin
  • Krystal J. Thomas-White
  • Elizabeth R. Mueller
  • Alan J. Wolfe
  • Qunfeng Dong
  • Linda BrubakerEmail author
Original Article


Introduction and hypothesis

Persistent and de novo symptoms decrease satisfaction after urogynecologic surgery. We investigated whether the preoperative bladder microbiome is associated with urinary symptoms prior to and after urogynecologic surgery.


One hundred twenty-six participants contributed responses to the validated OABq symptom questionnaire. Catheterized (bladder) urine samples and vaginal and perineal swabs were collected immediately preoperatively. Bacterial DNA in the urine samples and swabs was sequenced and classified.


Preoperative symptom severity was significantly worse in sequence-positive patients. Higher OABq Symptom Severity (OABqSS) scores (more symptomatic) were associated with higher abundance in bladder urine of two bacterial species: Atopobium vaginae and Finegoldia magna. The presence of Atopobium vaginae in bladder urine also was correlated with its presence in either the vagina or perineum.


Two specific bacterial species detected in bladder urine, Atopobium vaginae and Finegoldia magna, are associated with preoperative urinary symptom severity in women undergoing POP/SUI surgery. The reservoir for Atopobium vaginae may be adjacent pelvic floor niches. This observation should be validated in a larger cohort to determine whether there is a microbiologic etiology for certain preoperative urinary symptoms.


Microbiome Urinary incontinence Bladder Urinary symptoms 



Overactive Bladder Questionnaire


Urinary Distress Inventory


Pelvic Organ Prolapse Distress Inventory


Colorectal Anal Distress Inventory (CRADI)


Urinary tract infection


Pelvic organ prolapse


Urinary incontinence


Body mass index


Deoxyribonucleic acid


Polymerase chain reaction


Operational taxonomic unit


Stress urinary incontinence



We thank Mary Tulke, RN, for her assistance with participant recruitment and sample collection. We thank Noriko Shibata, MS, for her assistance with sample analysis. We also thank Dr. Michael Zilliox and Gina Kuffel of the Loyola Genomics Facility for performing the DNA sequencing.


This study was supported by NIH grants R21 DK097435 and P20 DK108268, a Falk Foundation grant (LU#202567), and financial support from the Society of Women in Urology.

Compliance with ethical standards

Conflicts of interest

L. Brubaker—Editorial Stipends: Journal of American Medical Association, Female Pelvic Medicine and Reconstructive Surgery, Up To Date; Research Funding: NIH; Board Stipend: American Board of Obstetrics and Gynecology.

A. J. Wolfe—Investigator Initiated Studies: Astellas Scientific and Medical Affairs, Inc.; Kimberly Clarke Corp.

E.R. Mueller—Astellas-Advisory Board, Boston Scientific-Advisory Board.

The remaining authors claim no conflicts of interest.

Supplementary material

192_2018_3732_MOESM1_ESM.pdf (12 kb)
Supplemental Figure 1. Fifteen most abundant bacterial genera detected in catheterized urine (A), vaginal swab (B), and perineal swab (C). The top 15 most abundant bacterial genera for each body site are displayed in standard box-and-whisker plots, with the mean values in diamonds and outliers in dots. (PDF 12 kb)
192_2018_3732_MOESM2_ESM.pdf (12 kb)
Supplemental Figure 1B (PDF 12 kb)
192_2018_3732_MOESM3_ESM.pdf (12 kb)
Supplemental Figure 1C (PDF 12 kb)


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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Cynthia S. Fok
    • 1
    • 2
  • Xiang Gao
    • 3
  • Huaiying Lin
    • 3
  • Krystal J. Thomas-White
    • 4
    • 5
  • Elizabeth R. Mueller
    • 1
  • Alan J. Wolfe
    • 4
  • Qunfeng Dong
    • 3
  • Linda Brubaker
    • 1
    • 6
    Email author
  1. 1.Departments of Obstetrics & Gynecology and Urology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  2. 2.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  3. 3.Department of Public Health, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  4. 4.Department of Microbiology and Immunology, Stritch School of MedicineLoyola University ChicagoMaywoodUSA
  5. 5.Menlo ParkUSA
  6. 6.Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive SurgeryUniversity of California San DiegoLa JollaUSA

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