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01-12-2018 | Original Article

Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients

Authors: Cynthia S. Fok, Xiang Gao, Huaiying Lin, Krystal J. Thomas-White, Elizabeth R. Mueller, Alan J. Wolfe, Qunfeng Dong, Linda Brubaker

Published in: International Urogynecology Journal | Issue 12/2018

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

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Riemsma R, Hagen S, Kirschner-Hermanns R, Norton C, Wijk H, Andersson KE, et al. Can incontinence be cured? A systematic review of cure rates. BMC Med. 2017;15:63.CrossRef

Burgio KL, Brubaker L, Richter HE, Wai CY, Litman HJ, France DB, et al. Patient satisfaction with stress incontinence surgery. Neurourol Urodyn. 2010;29:1403–9.CrossRef

Pham T, Kenton K, Mueller E, Brubaker L. New pelvic symptoms are common after reconstructive pelvic surgery. Am J Obstet Gynecol. 2009;200:88.e81–5.CrossRef

Karram MM, Segal JL, Vassallo BJ, Kleeman SD. Complications and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol. 2003;101:929–32.PubMed

Nygaard I, Brubaker L, Chai TC, Markland AD, Menefee SA, Sirls L, et al. Risk factors for urinary tract infection following incontinence surgery. Int Urogynecol J. 2011;22:1255–65.CrossRef

Gehrich AP, Patzwald JR, Kern ME, Squires CC, Lustik MB. The incidence of early and recurrent urinary tract infections after midurethral sling operations. Mil Med. 2014;179:1301–6.CrossRef

Fok CS, McKinley K, Mueller ER, Kenton K, Schreckenberger P, Wolfe A, et al. Day of surgery urine cultures identify urogynecologic patients at increased risk for postoperative urinary tract infection. J Urol. 2013;189:1721–4.CrossRef

Nienhouse V, Gao X, Dong Q, Nelson DE, Toh E, McKinley K, et al. Interplay between bladder microbiota and urinary antimicrobial peptides: mechanisms for human urinary tract infection risk and symptom severity. PLoS One. 2014;9:e114185.CrossRef

Karstens L, Asquith M, Davin S, Stauffer P, Fair D, Gregory WT, et al. Does the urinary microbiome play a role in urgency urinary incontinence and its severity? Front Cell Infect Microbiol. 2016;6:78.CrossRef

10.

Pearce MM, Hilt EE, Rosenfeld AB, Zilliox MJ, Thomas-White K, Fok C, et al. The female urinary microbiome: a comparison of women with and without urgency urinary incontinence. MBio. 2014;5:e01283–14.CrossRef

11.

Pearce MM, Zilliox MJ, Rosenfeld AB, Thomas-White KJ, Richter HE, Nager CW, et al. The female urinary microbiome in urgency urinary incontinence. Am J Obstet Gynecol. 2015;213:347.e341–11.CrossRef

12.

Thomas-White KJ, Hilt EE, Fok C, Pearce MM, Mueller ER, Kliethermes S, et al. Incontinence medication response relates to the female urinary microbiota. Int Urogynecol J. 2016;27:723–33.CrossRef

13.

Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185:1388–95.CrossRef

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.CrossRef

15.

Coyne K, Revicki D, Hunt T, Corey R, Stewart W, Bentkover J, et al. Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: the oab-q. Qual Life Res. 2002;11:563–74.CrossRef

16.

Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, et al. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012;50:1376–83.CrossRef

17.

Ackerman AL, Underhill DM. The mycobiome of the human urinary tract: potential roles for fungi in urology. Ann Transl Med. 2017;5:31.CrossRef

18.

Hilt EE, McKinley K, Pearce MM, Rosenfeld AB, Zilliox MJ, Mueller ER, et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol. 2014;52:871–6.CrossRef

19.

Yuan S, Cohen DB, Ravel J, Abdo Z, Forney LJ. Evaluation of methods for the extraction and purification of DNA from the human microbiome. PLoS One. 2012;7:e33865.CrossRef

20.

Schloss PD, Westcott SL, Ryabin T, Hall JR, Hartmann M, Hollister EB, et al. Introducing mothur: open-source, platform-independent, community-supported software for describing and comparing microbial communities. Appl Environ Microbiol. 2009;75:7537–41.CrossRef

21.

Edgar RC, Haas BJ, Clemente JC, Quince C, Knight R. Uchime improves sensitivity and speed of chimera detection. Bioinformatics. 2011;27:2194–200.CrossRef

22.

Wang Q, Garrity GM, Tiedje JM, Cole JR. Naive bayesian classifier for rapid assignment of rrna sequences into the new bacterial taxonomy. Appl Environ Microbiol. 2007;73:5261–7.CrossRef

23.

Gao X, Lin H, Revanna K, Dong Q. A bayesian taxonomic classification method for 16s rrna gene sequences with improved species-level accuracy. BMC Bioinformatics. 2017;18:247.CrossRef

24.

Polatti F. Bacterial vaginosis, atopobium vaginae and nifuratel. Curr Clin Pharmacol. 2012;7:36–40.CrossRef

25.

Knoester M, Lashley LE, Wessels E, Oepkes D, Kuijper EJ. First report of atopobium vaginae bacteremia with fetal loss after chorionic villus sampling. J Clin Microbiol. 2011;49:1684–6.CrossRef

26.

Bretelle F, Rozenberg P, Pascal A, Favre R, Bohec C, Loundou A, et al. High atopobium vaginae and gardnerella vaginalis vaginal loads are associated with preterm birth. Clin Infect Dis. 2015;60:860–7.CrossRef

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.CrossRef

28.

Zhou X, Brown CJ, Abdo Z, Davis CC, Hansmann MA, Joyce P, et al. Differences in the composition of vaginal microbial communities found in healthy caucasian and black women. ISME J. 2007;1:121–33.CrossRef

29.

Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SS, McCulle SL, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011;108(Suppl 1):4680–7.CrossRef

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.CrossRef

31.

Murphy EC, Frick IM. Gram-positive anaerobic cocci--commensals and opportunistic pathogens. FEMS Microbiol Rev. 2013;37:520–53.CrossRef

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.CrossRef

33.

Khasriya R, Sathiananthamoorthy S, Ismail S, Kelsey M, Wilson M, Rohn JL, et al. Spectrum of bacterial colonization associated with urothelial cells from patients with chronic lower urinary tract symptoms. J Clin Microbiol. 2013;51:2054–62.CrossRef

34.

Price TK, Dune T, Hilt EE, Thomas-White KJ, Kliethermes S, Brincat C, et al. The clinical urine culture: enhanced techniques improve detection of clinically relevant microorganisms. J Clin Microbiol. 2016;54(5):1216–1222.CrossRef

35.

Coorevits L, Heytens S, Boelens J, Claeys G. The resident microflora of voided midstream urine of healthy controls: standard versus expanded urine culture protocols. Eur J Clin Microbiol Infect Dis. 2016;36(4):635–639.CrossRef

Title: Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients
Authors: Cynthia S. Fok
Xiang Gao
Huaiying Lin
Krystal J. Thomas-White
Elizabeth R. Mueller
Alan J. Wolfe
Qunfeng Dong
Linda Brubaker
Publication date: 01-12-2018
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 12/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3732-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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