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The gut, vaginal, and urine microbiome in overactive bladder: a systematic review


Introduction and hypothesis

The objective was to systemically review the current literature on the association of gut, vaginal, and urinary dysbiosis in female patients with overactive bladder (OAB).


We performed a comprehensive literature search following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols for systematic reviews. In the EMBASE, CINAHL, and Medline databases, a search was conducted using key words such as “microbiome,” “microbiota,” “microflora,” “overactive bladder,” “urge,” “gut,” “vaginal.” Articles were screened using the online tool Two independent reviewers screened studies at each stage and resolved conflicts together. We excluded papers that discussed pediatric patients and animal studies. In total, 13 articles met this criterion, which included 6 abstracts.


After identifying 817 unique references, 13 articles met the criteria for data extraction. Articles were published from 2017 to 2021. No study reported the same microbiota abundance, even in healthy individuals. Overall, there was a loss of bacterial diversity in OAB patients compared with controls. Additionally, the bacterial composition of the controls and OAB patients was not significantly different, especially if the urine was collected midstream. Overall, the composition of the microbiome is dependent on the specimen collection methodology, and the metagenomic sequencing technique utilized. OAB urine microbiome is more predisposed to alteration from the gut or vaginal influences than in controls.


Current evidence suggested a potential relationship among gut, vaginal, and urinary microbiome in OAB patients, but there are very limited studies.

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Fig. 1



Benign prostatic hyperplasia


Detrusor overactivity


Enhanced quantitative urine culture


Fecal microbiota transplantation


Lower urinary tract symptoms


Midstream urine


Overactive bladder


Short-chain fatty acids


Transurethral catheterized urine


Urge urinary incontinence


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Authors and Affiliations



Study concept and design: Christina Sze, Mariel Pressler; acquisition of data: Christina Sze, Mariel Pressler; analysis and interpretation of data: none; drafting of the manuscript: Christina Sze, Mariel Pressler; critical revision of the manuscript for important intellectual content: Christina Sze, Mariel Pressler, John Richard Lee, Bilal Chughtai; supervision: Bilal Chughtai.

Corresponding author

Correspondence to Bilal Chughtai.

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Conflicts of interest

Christina Sze: none; Mariel Pressler: none; John Richard Lee: holds patent US-2020-0048713-A1 entitled “Methods of Detecting Cell-Free DNA in Biological Samples” and receives research support under an investigator-initiated research grant from BioFire Diagnostics, LLC; Bilal Chughtai: consultant for Allergan and Boston Scientific.

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Sze, C., Pressler, M., Lee, J.R. et al. The gut, vaginal, and urine microbiome in overactive bladder: a systematic review. Int Urogynecol J 33, 1157–1164 (2022).

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  • Microbiome
  • Overactive bladder
  • Vaginal
  • Gut
  • Urine