RESUMO
BACKGROUND: Urinary microbiome (urobiome) studies have previously reported on specific taxa and community differences in women with mixed urinary incontinence compared with controls. Therefore, a hypothesis was made that higher urinary and vaginal microbiome diversity would be associated with increased urinary incontinence severity. OBJECTIVE: This study aimed to test whether specific urinary or vaginal microbiome community types are associated with urinary incontinence severity in a population of women with mixed urinary incontinence. STUDY DESIGN: This planned secondary, cross-sectional analysis evaluated associations between the urinary and vaginal microbiomes and urinary incontinence severity in a subset of Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence trial participants with urinary incontinence. Incontinence severity was measured using bladder diaries and Urinary Distress Inventory questionnaires collected at baseline. Catheterized urine samples and vaginal swabs were concurrently collected before treatment at baseline to assess the urinary and vaginal microbiomes. Of note, 16S rRNA V4 to V6 variable regions were sequenced, characterizing bacterial taxa to the genus level using the DADA2 pipeline and SILVA database. Using Dirichlet multinomial mixtures methods, samples were clustered into community types based on core taxa. Associations between community types and severity measures (Urinary Distress Inventory total scores, Urinary Distress Inventory subscale scores, and the number of urinary incontinence episodes [total, urgency, and stress] from the bladder diary) were evaluated using linear regression models adjusted for age and body mass index. In addition, alpha diversity measures for richness (total taxa numbers) and evenness (proportional distribution of taxa abundance) were analyzed for associations with urinary incontinence episodes and community type. RESULTS: Overall, 6 urinary microbiome community types were identified, characterized by varying levels of common genera (Lactobacillus, Gardnerella, Prevotella, Tepidimonas, Acidovorax, Escherichia, and others). The analysis of urinary incontinence severity in 126 participants with mixed urinary incontinence identified a Lactobacillus-dominated reference group with the highest abundance of Lactobacillus (mean relative abundance of 76%). A community characterized by fewer Lactobacilli (mean relative abundance of 19%) and greater alpha diversity was associated with higher total urinary incontinence episodes (2.67 daily leaks; 95% confidence interval, 0.76-4.59; P=.007) and urgency urinary incontinence episodes (1.75 daily leaks; 95% confidence interval, 0.24-3.27; P=.02) than the reference group. No significant association was observed between community type and stress urinary incontinence episodes or Urogenital Distress Inventory total or subscores. The composition of vaginal community types and urinary community types were similar but composed of slightly different bacterial taxa. Vaginal community types were not associated with urinary incontinence severity, as measured by bladder diary or Urogenital Distress Inventory total and subscale scores. Alpha diversity indicated that greater sample richness was associated with more incontinence episodes (observed genera P=.01) in urine. Measures of evenness (Shannon and Pielou) were not associated with incontinence severity in the urinary or vaginal microbiomes. CONCLUSION: In the urobiome of women with mixed urinary incontinence, a community type with fewer Lactobacilli and more diverse bacteria was associated with more severe urinary incontinence episodes (total and urgency) compared with a community type with high predominance of a single genus, Lactobacillus. Whether mixed urinary incontinence severity is due to lesser predominance of Lactobacillus, greater presence of other non-Lactobacillus genera, or the complement of bacteria consisting of urobiome community types remains to be determined.
Assuntos
Microbiota , Índice de Gravidade de Doença , Vagina , Humanos , Feminino , Vagina/microbiologia , Pessoa de Meia-Idade , Estudos Transversais , Incontinência Urinária/microbiologia , Adulto , Urina/microbiologia , Idoso , RNA Ribossômico 16S , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária de Urgência/microbiologiaRESUMO
BACKGROUND: Since the discovery of the bladder microbiome (urobiome), interest has grown in learning whether urobiome characteristics have a role in clinical phenotyping and provide opportunities for novel therapeutic approaches for women with common forms of urinary incontinence. OBJECTIVE: This study aimed to test the hypothesis that the bladder urobiome differs among women in the control cohort and women affected by urinary incontinence by assessing associations between urinary incontinence status and the cultured urobiome. STUDY DESIGN: With institutional review board oversight, urine specimens from 309 adult women were collected through transurethral catheterization. These women were categorized into 3 cohorts (continent control, stress urinary incontinence [SUI], and urgency urinary incontinence [UUI]) based on their responses to the validated Pelvic Floor Distress Inventory (PFDI) questionnaire. Among 309 women, 150 were in the continent control cohort, 50 were in the SUI cohort, and 109 were in the UUI cohort. Symptom severity was assessed by subscale scoring with the Urinary Distress Inventory (UDI), subscale of the Pelvic Floor Distress Inventory. Microbes were assessed by expanded quantitative urine culture protocol, which detects the most common bladder microbes (bacteria and yeast). Microbes were identified to the species level by matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Alpha diversity indices were calculated for culture-positive samples and compared across the 3 cohorts. The correlations of UDI scores, alpha diversity indices, and species abundance were estimated. RESULTS: Participants had a mean age of 53 years (range 22-90); most were whites (65%). Women with urinary incontinence were slightly older (control, 47; SUI, 54; UUI, 61). By design, UDI symptom scores differed (control, 8.43 [10.1]; SUI, 97.95 [55.36]; UUI, 93.71 [49.12]; P<.001). Among 309 participants, 216 (70%) had expanded quantitative urine culture-detected bacteria; furthermore, the urinary incontinence cohorts had a higher detection frequency than the control cohort (control, 57%; SUI, 86%; UUI, 81%; P<.001). In addition, the most frequently detected species among the cohorts were as follows: continent control, Lactobacillus iners (12.7%), Streptococcus anginosus (12.7%), L crispatus (10.7%), and L gasseri (10%); SUI, S anginosus (26%), L iners (18%), Staphylococcus epidermidis (18%), and L jensenii (16%); and UUI, S anginosus (30.3%), L gasseri (22%), Aerococcus urinae (18.3%), and Gardnerella vaginalis (17.4%). However, only Actinotignum schaalii (formerly Actinobaculum schaalii), A urinae, A sanguinicola, and Corynebacterium lipophile group were found at significantly higher mean abundances in 1 of the urinary incontinence cohorts when compared with the control cohort (Wilcoxon rank sum test; P<.02), and no individual genus differed significantly between the 2 urinary incontinence cohorts. Both urinary incontinence cohorts had increased alpha diversity similar to continent control cohort with indices of species richness, but not evenness, strongly associated with urinary incontinence. CONCLUSION: In adult women, the composition of the culturable bladder urobiome is associated with urinary incontinence, regardless of common incontinence subtype. Detection of more unique living microbes was associated with worsening incontinence symptom severity. Culturable species richness was significantly greater in the urinary incontinence cohorts than in the continent control cohort.
Assuntos
Biodiversidade , Microbiota , Bexiga Urinária/microbiologia , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária de Urgência/microbiologia , Actinomycetaceae/isolamento & purificação , Adulto , Aerococcus/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Corynebacterium/isolamento & purificação , Estudos Transversais , Feminino , Gardnerella vaginalis/isolamento & purificação , Humanos , Lactobacillus/isolamento & purificação , Lactobacillus crispatus/isolamento & purificação , Lactobacillus gasseri/isolamento & purificação , Pessoa de Meia-Idade , Staphylococcus epidermidis/isolamento & purificação , Streptococcus anginosus/isolamento & purificação , Adulto JovemRESUMO
INTRODUCTION AND HYPOTHESIS: We describe the rationale and methods of a study designed to compare vaginal and urinary microbiomes in women with mixed urinary incontinence (MUI) and similarly aged, asymptomatic controls. METHODS: This paper delineates the methodology of a supplementary microbiome study nested in an ongoing randomized controlled trial comparing a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone for MUI. Women in the parent study had at least "moderate bother" from urgency and stress urinary incontinence symptoms (SUI) on validated questionnaire and confirmed MUI on bladder diary. Controls had no incontinence symptoms. All participants underwent vaginal and urine collection for DNA analysis and conventional urine culture. Standardized protocols were designed, and a central lab received samples for subsequent polymerase chain reaction (PCR) amplification and sequencing of the bacterial16S ribosomal RNA (rRNA) gene. The composition of bacterial communities will be determined by dual amplicon sequencing of variable regions 1-3 and 4-6 from vaginal and urine specimens to compare the microbiome of patients with controls. Sample-size estimates determined that 126 MUI and 84 control participants were sufficient to detect a 20 % difference in predominant urinary genera, with 80 % power and 0.05 significance level. RESULTS: Specimen collection commenced January 2015 and finished April 2016. DNA was extracted and stored for subsequent evaluation. CONCLUSIONS: Methods papers sharing information regarding development of genitourinary microbiome studies, particularly with control populations, are few. We describe the rigorous methodology developed for a novel urogenital microbiome study in women with MUI.
Assuntos
Microbiota , Projetos de Pesquisa , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária de Urgência/microbiologia , Feminino , Humanos , Microbiota/genética , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Análise de Sequência de DNA , Inquéritos e Questionários , Vagina/microbiologiaRESUMO
BACKGROUND: Female urinary microbiota are associated with urgency urinary incontinence and response to medication. The urinary microbiota of women with stress urinary incontinence has not been described. OBJECTIVE: We sought to study the cross-sectional relationships between urinary microbiota features and demographic and clinical characteristics of women undergoing stress urinary incontinence surgery. STUDY DESIGN: Preoperative urine specimens were collected from women without urinary tract infection and were available from 197 women (174 voided, 23 catheterized) enrolled in a multicenter prospective randomized trial, the Value of Urodynamic Evaluation study. Demographic and clinical variables were obtained including stress and urgency urinary incontinence symptoms, menopausal status, and hormone use. The bacterial composition of the urine was qualitatively assessed by sequencing the bacterial 16S ribosomal RNA gene. Phylogenetic relatedness and microbial alpha diversity were compared to demographics and symptoms using generalized estimating equation models. RESULTS: The majority of 197 urine samples (86%) had detectable bacterial DNA. Bacterial diversity was significantly associated with higher body mass index (P = .02); increased Medical, Epidemiologic, and Social Aspects of Aging urge index score (P = .04); and hormonal status (P < .001). No associations were detected with stress urinary incontinence symptoms. Increased diversity was also associated with a concomitant lower frequency of Lactobacillus in hormone-negative women. CONCLUSION: Women undergoing stress urinary incontinence surgery have detectable urinary microbiota. This cross-sectional analysis revealed that increased diversity of the microbiota was associated with urgency urinary incontinence symptoms, hormonal status, and body mass index. In contrast, the female urinary microbiota were not associated with stress urinary incontinence symptoms.
Assuntos
DNA Bacteriano/urina , Microbiota/genética , RNA Ribossômico 16S/genética , Incontinência Urinária por Estresse/microbiologia , Urina/microbiologia , Actinobacteria/genética , Adulto , Técnicas de Tipagem Bacteriana , Biodiversidade , Índice de Massa Corporal , Corynebacterium/genética , Estudos Transversais , Feminino , Humanos , Lactobacillus/genética , Pessoa de Meia-Idade , Filogenia , Prevotella/genética , Ensaios Clínicos Controlados Aleatórios como Assunto , Streptococcus/genéticaRESUMO
The aims were to determine whether bacteria-infection-elicited immune response after mid-urethral sling (MUS) may cause de novo urge symptoms (DNUS) and to evaluate the efficacy of suburethral sling excision for relieving the urgency. In a period of 40 months, 360 consecutive subjects with urodynamic stress incontinence had undergone one of three different MUS. Sixty-eight women with DNUS were included after exclusion. The suburethral sling of 24 of the 68 women needed to be excised because of refractory urgency. The excised vagina, or periurethral tissue, included sling of the study and control groups were sent for microbiological and immunohistochemical analyses. Statistically significant differences in the cell density percentage of CD68, CD25, CD4+CD25 and positive rate of Gram (+) bacteria were noted between two groups (p=0.024, p=0.053 and 0.016, respectively, p<0.001). The success rate of sling excision was 80.2%. In conclusion, bacteria-infection-related immune hyperreactivity might explain the pathologic basis of DNUS after MUS.
Assuntos
Slings Suburetrais , Incontinência Urinária de Urgência/microbiologia , Adulto , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Contagem de Células , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Uretra/metabolismo , Uretra/microbiologia , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/epidemiologia , Vagina/metabolismo , Vagina/microbiologiaRESUMO
OBJECTIVE: To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men. DESIGN: Cross-sectional study. SETTING: The catchment area of a primary healthcare centre in a Swedish middle-sized town. SUBJECTS: Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537). MAIN OUTCOME MEASURES: Urinary cultures and questionnaire data on urinary incontinence. RESULTS: In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35-5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49-7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence. CONCLUSION: Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.
Assuntos
Bacteriúria/complicações , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária de Urgência/microbiologia , Idoso de 80 Anos ou mais , Bacteriúria/epidemiologia , Bacteriúria/urina , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , Suécia/epidemiologia , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/urina , Incontinência Urinária de Urgência/epidemiologia , Incontinência Urinária de Urgência/urinaRESUMO
AIM: A prospective study was performed to determine the incidence of significant bacteriuria and to identify the risk factors for bacteriuria after urodynamic studies (UDSs) in women with urodynamic stress urinary incontinence (SUI). METHODS: A total of 225 women with urodynamic SUI were evaluated. All women were negative on double-screened urine cultures, in clean-catch midstream urine (MSU) specimens, before UDS. Another urine specimen was obtained for urinalysis and culture at 3-7 days after UDS. Urinary culture with 10(5) CFU/ml or more was regarded as significant bacteriuria. To identify the risk factors for significant bacteriuria, the clinical characteristics of all patients including age, BMI, parity, medical and operation history, degree of pelvic organ prolapse, results of urinalysis, and UDS were evaluated. RESULTS: The prevalence of significant bacteriuria was 6.2%. The most common identified microorganism was Escherichia coli (57.1%). Univariate analysis demonstrated that a history of recurrent urinary tract infection (UTI; P = 0.002) and urological surgery or procedure (P = 0.02) were significant predictors of significant bacteriuria. On multiple logistic regression analysis the past history of recurrent UTI was the only significant independent risk factor (OR = 28.5, 95% CI = 4.309-188.488, P = 0.009). CONCLUSIONS: This study suggests that for most women with SUI it may be unnecessary to use preventive prophylactic antibiotics in UDS. However, our results suggest that in patients with a previous history of recurrent UTI or urologic surgery the risk for significant bacteriuria is increased and use of prophylactic antibiotics should be considered.
Assuntos
Bacteriúria/complicações , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica/fisiologia , Adulto , Comorbidade , Complicações do Diabetes , Feminino , Humanos , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Paridade , Gravidez , Fatores de Risco , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/microbiologiaRESUMO
Stress urine incontinence was treated in 79 women with Burch laparoscopic colposuspension, 75 (94.9%) of them had chronic urinary infection. 42 females of group 1 received postoperative extracorporeal hemocorrection, 37 females of group 2 received conventional postoperative therapy. In group 1 the treatment reduced leukocyturia, bacteriuria was detected in 9 (21.4%) patients, recurrent incontinence occurred in 2 (5.9%) women. In group 2 leukocyturia enhanced, bacteriuria and incontinence recurrence were observed in 23 (62.2%) and 8 (23.5%) patients, respectively. The results of the study show that combined use of laparoscopic colposuspension by Burch and extracorporeal hemocorrection improves the results of the treatment of stress urine incontinence.
Assuntos
Laparoscopia/métodos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Contagem de Linfócitos , Linfócitos/citologia , Linfócitos/imunologia , Pessoa de Meia-Idade , Qualidade de Vida , Incontinência Urinária por Estresse/imunologia , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária por Estresse/fisiopatologia , Infecções Urinárias/imunologia , Infecções Urinárias/microbiologia , Infecções Urinárias/fisiopatologia , Urina/microbiologia , Urodinâmica/fisiologiaRESUMO
Urine samples were cultured for aerobic, fastidious, and anaerobic bacteria in 88 patients (66 F, 22 M) before and after standard urodynamic investigations. 37 of 42 women with detrusor instability, and 14 of 17 women with stress incontinence, had evidence of bacteriuria with aerobic or fastidious bacteria before investigation, as did 6 of 13 men with bladder outflow obstruction. 8 men (36%) acquired bacteriuria with aerobic bacteria after investigation, compared with 10 women (15%). Recalcitrant, irritative urinary symptoms in women may be caused by an underlying infection, the urodynamic changes being secondary. In men who have urodynamic studies, antibiotic prophylaxis should be considered.
Assuntos
Bacteriúria/etiologia , Urodinâmica , Técnicas Bacteriológicas , Bacteriúria/complicações , Bacteriúria/diagnóstico , Contagem de Colônia Microbiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Bexiga Urinária/microbiologia , Doenças da Bexiga Urinária/urina , Cateterismo Urinário/efeitos adversos , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária por Estresse/urinaAssuntos
Infecções Bacterianas/microbiologia , Cistite/microbiologia , Uretrite/microbiologia , Incontinência Urinária por Estresse/microbiologia , Vagina/microbiologia , Adulto , Infecções Bacterianas/complicações , Cistite/complicações , Feminino , Humanos , Uretra/microbiologia , Uretrite/complicações , Bexiga Urinária/microbiologia , Incontinência Urinária por Estresse/etiologiaRESUMO
We studied 41 patients with chronic interstitial cystitis. Histological examination of bladder lesions revealed mucosal ulceration, pancystitis and perineural inflammatory infiltrates. Perineural cell infiltration is related probably to the characteristic symptoms of the disease. A search for a viral etiology, particularly herpes simplex virus, rendered negative results.