title: Evaluation of the urinary microbiota of women with uncomplicated stress urinary incontinence.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University, Chicago, IL.
authors: Krystal J
authors: KJ
authors: Thomas-White
authors: Departments of Medicine and Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors: Stephanie
authors: S
authors: Kliethermes
authors: Department of Urology, Yale University, New Haven, CT.
authors: Leslie
authors: L
authors: Rickey
authors: Department of Reproductive Medicine, University of California-San Diego Health System, San Diego, CA.
authors: Emily S
authors: ES
authors: Lukacz
authors: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.
authors: Holly E
authors: HE
authors: Richter
authors: Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA.
authors: Pamela
authors: P
authors: Moalli
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Philippe
authors: P
authors: Zimmern
authors: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors: Peggy
authors: P
authors: Norton
authors: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors: John W
authors: JW
authors: Kusek
authors: Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University, Chicago, IL. Electronic address: awolfe@luc.edu.
authors: Alan J
authors: AJ
authors: Wolfe
authors: Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL.
authors: Linda
authors: L
authors: Brubaker
mesh_terms: D039903:Actinobacteria / Q000235:genetics; D000328:Adult; D015373:Bacterial Typing Techniques; D044822:Biodiversity; D015992:Body Mass Index; D003352:Corynebacterium / Q000235:genetics; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000652:urine*; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000235:genetics; D064307:Microbiota / Q000235:genetics*; D008875:Middle Aged; D010802:Phylogeny; D018720:Prevotella / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D016032:Randomized Controlled Trials as Topic; D013291:Streptococcus / Q000235:genetics; D014550:Urinary Incontinence, Stress / Q000382:microbiology*; D014556:Urine / Q000382:microbiology*
chemical_list: D004269:DNA, Bacterial; D012336:RNA, Ribosomal, 16S
keywords: bladder; estrogen; microbiome; stress urinary incontinence; urgency urinary incontinence