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Impact of microbiota and host immunologic response on the efficacy of anticholinergic treatment for urgency urinary incontinence

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Abstract

Introduction and hypothesis

Studies within the past decade have suggested associations among composition of the urinary microbiota, local immune responses, and urinary incontinence symptoms. To investigate these relationships, we evaluated the structure of the urinary microbiome, local inflammatory markers, and patient responses prior to and at 6-weeks after treatment with anticholinergic medication for urgency urinary incontinence (UUI).

Methods

Using a prospective pilot study, we enrolled women who presented with UUI symptoms and were prescribed treatment with anticholinergics. Catheterized urine samples were collected from participants at their baseline and 6-week follow-up visits for microbiological (standard and 16S rRNA gene phylotyping analyses) and cytokine analysis along with the UDI-6 questionnaire and 2-day bladder diary.

Results

Patients were Caucasian, post- menopausal, with a median age of 64 and median BMI of 30.1 kg/m2. Among the patients, 75% had UUI symptoms for less than 2 years, but with a frequency of at least a few times a week or every day. Most women were prescribed 10 mg oxybutynin ER daily at enrollment. Patients had varied urinary microbiota by culture and 16S phylotyping, with species of Lactobacillus being the most common, in six samples, in addition to taxa associated with Enterococcus, Staphylococcus, and mixed flora. Cytokine levels showed no differences before and after treatment with anticholinergics, nor correlation with urinary bacteria or microbiome composition.

Conclusions

Our pilot study suggests factors in addition to the urinary microbiome and local immune responses may be involved in patients’ response to anticholinergics for UUI.

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Data Availability

Data available upon request from authors.

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Funding

This study was supported through a restricted grant from the Medical University of Silesia and the International Urogynecological Association, and by the Harvard Digestive Diseases P30 DK034854 grant from the National Institutes of Health/NIDDK.

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Authors and Affiliations

  1. Division of Urogynecology, Brigham and Women’s Hospital, 500 Brookline Ave, Suite E, Boston, MA, 02115, USA

    Iwona Gabriel, Alexa Courtepatte & Vatche A. Minassian

  2. Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland

    Iwona Gabriel

  3. Massachusetts Host-Microbiome Center, Department of Pathology, Brigham & Women’s Hospital, Boston, MA, USA

    Mary Louise Delaney & Lynn Bry

  4. Evans Biomedical Research Center, Boston, MA, USA

    Matthew Au

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  1. Iwona Gabriel
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  2. Mary Louise Delaney
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  4. Alexa Courtepatte
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  5. Lynn Bry
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Contributions

Gabriel I: Project development, data collection, manuscript writing.

Delaney ML: Project development, data analysis.

Au M: Project development, data analysis.

Courtepatte A: Data analysis.

Lynn Bry: Project development, manuscript editing.

Minassian VA: Project development, manuscript writing.

Corresponding author

Correspondence to Alexa Courtepatte.

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The authors declare that they have no conflict of interest.

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Gabriel, I., Delaney, M.L., Au, M. et al. Impact of microbiota and host immunologic response on the efficacy of anticholinergic treatment for urgency urinary incontinence. Int Urogynecol J 34, 3041–3050 (2023). https://doi.org/10.1007/s00192-023-05664-5

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  • DOI: https://doi.org/10.1007/s00192-023-05664-5

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