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

A Commentary to this article was published on 17 September 2018

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

OABq :

Overactive Bladder Questionnaire

UDI :

Urinary Distress Inventory

POPDI :

Pelvic Organ Prolapse Distress Inventory

CRADI :

Colorectal Anal Distress Inventory (CRADI)

UTI :

Urinary tract infection

POP :

Pelvic organ prolapse

UI :

Urinary incontinence

BMI :

Body mass index

DNA :

Deoxyribonucleic acid

PCR :

Polymerase chain reaction

OTU :

Operational taxonomic unit

SUI :

Stress urinary incontinence

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Acknowledgments

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.

Funding

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.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Linda Brubaker.

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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.

Electronic supplementary material

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)

Supplemental Figure 1B

(PDF 12 kb)

Supplemental Figure 1C

(PDF 12 kb)

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Fok, C.S., Gao, X., Lin, H. et al. Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients. Int Urogynecol J 29, 1765–1771 (2018). https://doi.org/10.1007/s00192-018-3732-1

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  • DOI: https://doi.org/10.1007/s00192-018-3732-1

Keywords

  • Microbiome
  • Urinary incontinence
  • Bladder
  • Urinary symptoms