Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients
Introduction and hypothesis
Persistent and de novo symptoms decrease satisfaction after urogynecologic surgery. We investigated whether the preoperative bladder microbiome is associated with urinary symptoms prior to and after urogynecologic surgery.
One hundred twenty-six participants contributed responses to the validated OABq symptom questionnaire. Catheterized (bladder) urine samples and vaginal and perineal swabs were collected immediately preoperatively. Bacterial DNA in the urine samples and swabs was sequenced and classified.
Preoperative symptom severity was significantly worse in sequence-positive patients. Higher OABq Symptom Severity (OABqSS) scores (more symptomatic) were associated with higher abundance in bladder urine of two bacterial species: Atopobium vaginae and Finegoldia magna. The presence of Atopobium vaginae in bladder urine also was correlated with its presence in either the vagina or perineum.
Two specific bacterial species detected in bladder urine, Atopobium vaginae and Finegoldia magna, are associated with preoperative urinary symptom severity in women undergoing POP/SUI surgery. The reservoir for Atopobium vaginae may be adjacent pelvic floor niches. This observation should be validated in a larger cohort to determine whether there is a microbiologic etiology for certain preoperative urinary symptoms.
KeywordsMicrobiome Urinary incontinence Bladder Urinary symptoms
Overactive Bladder Questionnaire
Urinary Distress Inventory
Pelvic Organ Prolapse Distress Inventory
Colorectal Anal Distress Inventory (CRADI)
Urinary tract infection
Pelvic organ prolapse
Body mass index
Polymerase chain reaction
Operational taxonomic unit
Stress urinary incontinence
We thank Mary Tulke, RN, for her assistance with participant recruitment and sample collection. We thank Noriko Shibata, MS, for her assistance with sample analysis. We also thank Dr. Michael Zilliox and Gina Kuffel of the Loyola Genomics Facility for performing the DNA sequencing.
This study was supported by NIH grants R21 DK097435 and P20 DK108268, a Falk Foundation grant (LU#202567), and financial support from the Society of Women in Urology.
Compliance with ethical standards
Conflicts of interest
L. Brubaker—Editorial Stipends: Journal of American Medical Association, Female Pelvic Medicine and Reconstructive Surgery, Up To Date; Research Funding: NIH; Board Stipend: American Board of Obstetrics and Gynecology.
A. J. Wolfe—Investigator Initiated Studies: Astellas Scientific and Medical Affairs, Inc.; Kimberly Clarke Corp.
E.R. Mueller—Astellas-Advisory Board, Boston Scientific-Advisory Board.
The remaining authors claim no conflicts of interest.
- 14.Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Continence program for women research group. Neurourol Urodyn. 1995;14:131–9.CrossRefGoogle Scholar
- 27.Bretelle F, Fenollar F, Baumstarck K, Fortanier C, Cocallemen JF, Serazin V, et al. Screen-and-treat program by point-of-care of atopobium vaginae and gardnerella vaginalis in preventing preterm birth (autop trial): study protocol for a randomized controlled trial. Trials. 2015;16:470.CrossRefGoogle Scholar
- 30.De Backer E, Verhelst R, Verstraelen H, Alqumber MA, Burton JP, Tagg JR, et al. Quantitative determination by real-time pcr of four vaginal lactobacillus species, gardnerella vaginalis and atopobium vaginae indicates an inverse relationship between l. Gasseri and l Iners. BMC Microbiol. 2007;7:115.CrossRefGoogle Scholar
- 32.Fouts DE, Pieper R, Szpakowski S, Pohl H, Knoblach S, Suh MJ, et al. Integrated next-generation sequencing of 16s rdna and metaproteomics differentiate the healthy urine microbiome from asymptomatic bacteriuria in neuropathic bladder associated with spinal cord injury. J Transl Med. 2012;10:174.CrossRefGoogle Scholar