title: Does the Urinary Microbiome Play a Role in Urgency Urinary Incontinence and Its Severity?
abstract: Traditionally, the urinary tract has been thought to be sterile in the absence of a clinically identifiable infection. However, recent evidence suggests that the urinary tract harbors a variety of bacterial species, known collectively as the urinary microbiome, even when clinical cultures are negative. Whether these bacteria promote urinary health or contribute to urinary tract disease remains unknown. Emerging evidence indicates that a shift in the urinary microbiome may play an important role in urgency urinary incontinence (UUI). The goal of this prospective pilot study was to determine how the urinary microbiome is different between women with and without UUI. We also sought to identify if characteristics of the urinary microbiome are associated with UUI severity.
  
  
  
  We collected urine from clinically well-characterized women with UUI (n = 10) and normal bladder function (n = 10) using a transurethral catheter to avoid bacterial contamination from external tissue. To characterize the resident microbial community, we amplified the bacterial 16S rRNA gene by PCR and performed sequencing using Illumina MiSeq. Sequences were processed using the workflow package QIIME. We identified bacteria that had differential relative abundance between UUI and controls using DESeq2 to fit generalized linear models based on the negative binomial distribution. We also identified relationships between the diversity of the urinary microbiome and severity of UUI symptoms with Pearson's correlation coefficient.
  
  
  
  We successfully extracted and sequenced bacterial DNA from 95% of the urine samples and identified that there is a polymicrobial community in the female bladder in both healthy controls and women with UUI. We found the relative abundance of 14 bacteria significantly differed between control and UUI samples. Furthermore, we established that an increase in UUI symptom severity is associated with a decrease in microbial diversity in women with UUI.
  
  
  
  Our study provides further characterization of the urinary microbiome in both healthy controls and extensively phenotyped women with UUI. Our results also suggest that the urinary microbiome may play an important role in the pathophysiology of UUI and that the loss of microbial diversity may be associated with clinical severity.
authors: Division of Bioinformatics and Computational Biology, Oregon Health and Science UniversityPortland, OR, USA; Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA.
authors: Lisa
authors: L
authors: Karstens
authors: Division of Arthritis and Rheumatology, Oregon Health and Science University Portland, OR, USA.
authors: Mark
authors: M
authors: Asquith
authors: Division of Arthritis and Rheumatology, Oregon Health and Science University Portland, OR, USA.
authors: Sean
authors: S
authors: Davin
authors: Division of Arthritis and Rheumatology, Oregon Health and Science University Portland, OR, USA.
authors: Patrick
authors: P
authors: Stauffer
authors: Department of Behavioral Neuroscience, Oregon Health and Science UniversityPortland, OR, USA; Department of Psychiatry, Oregon Health and Science UniversityPortland, OR, USA; Advanced Imaging Research Center, Oregon Health and Science UniversityPortland, OR, USA.
authors: Damien
authors: D
authors: Fair
authors: Division of Urogynecology, Oregon Health and Science University Portland, OR, USA.
authors: W Thomas
authors: WT
authors: Gregory
authors: Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA; Devers Eye Institute, Oregon Health and Science UniversityPortland, OR, USA.
authors: James T
authors: JT
authors: Rosenbaum
authors: Division of Bioinformatics and Computational Biology, Oregon Health and Science University Portland, OR, USA.
authors: Shannon K
authors: SK
authors: McWeeney
authors: Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA; Kaiser PermanenteClackamas, OR, USA.
authors: Rahel
authors: R
authors: Nardos
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D001483:Base Sequence; D044822:Biodiversity; D016022:Case-Control Studies; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D064307:Microbiota / Q000235:genetics / Q000502:physiology*; D008875:Middle Aged; D010802:Phylogeny; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D001745:Urinary Bladder Diseases / Q000382:microbiology / Q000652:urine; D014549:Urinary Incontinence / Q000382:microbiology* / Q000503:physiopathology / Q000652:urine; D014551:Urinary Tract / Q000382:microbiology
chemical_list: D004269:DNA, Bacterial
keywords: bladder disease; bladder microbiome; human microbiome; overactive bladder; urge; urinary incontinence; urinary microbiome