International Urogynecology Journal, 2014, Vol.25(9), pp.1179-1184
Byline: Linda Brubaker (1), Charles W. Nager (2), Holly E. Richter (3), Anthony Visco (4), Ingrid Nygaard (5), Matthew D. Barber (6), Joseph Schaffer (7), Susan Meikle (8), Dennis Wallace (9), Noriko Shibata (10), Alan J. Wolfe (10) Keywords: Microbiome; Urinary bacteria; Urinary urgency incontinence; Urinary tract infection Abstract: Introduction and hypothesis This study's aims were to detect and quantify bacterial DNA in the urine of randomized trial participants about to undergo treatment for urinary urgency incontinence (UUI) without clinical evidence of urinary tract infection (UTI) and to determine if the presence of bacterial DNA in baseline urine relates to either baseline urinary symptoms or UTI risk after urinary tract instrumentation. Methods Women without clinical evidence of baseline UTI were randomized to cystoscopic onabotulinum toxin A injection and oral placebo medication versus cystoscopic placebo injection and active oral medication. Bacterial DNA in participants' catheterized urine was measured by quantitative polymerase chain reaction (qPCR). Results Bacterial DNA was detected in the urine of 38.7 % of participants (60 out of 155). In these 60 qPCR-positive participants, baseline daily UUI episodes were greater than in the 95 qPCR-negative participants (5.71 [[+ or -]2.60] vs 4.72 [[+ or -]2.86], p=0.004). Neither symptom severity by questionnaire nor treatment outcome was associated with qPCR status or with qPCR level in qPCR-positive subjects. In contrast, the presence of urinary bacterial DNA was associated with UTI risk: only 10 % of the qPCR-positive women developed a UTI post-treatment, while 24 % of the qPCR-negative women did so. The median qPCR level for qPCR-positive samples did not differ significantly by UTI status (UTI 2.58x10.sup.5 vs no UTI 1.35x10.sup.5 copies/mL, p=0.6). Conclusions These results may indicate a urinary bacterial contribution to both baseline UUI and the risk of post-treatment UTI. Author Affiliation: (1) Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Avenue, Boulevard 120, Room 420, Maywood, IL, 60153, USA (2) Department of Reproductive Medicine, UC San Diego Health System, San Diego, San Diego, CA, USA (3) Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA (4) Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA (5) Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA (6) Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA (7) Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA (8) Gynecologic Health and Disease Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA (9) Health Sciences Division, Research Triangle Institute, Research Triangle Park, NC, USA (10) Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA Article History: Registration Date: 29/12/2013 Received Date: 10/10/2013 Accepted Date: 28/12/2013 Online Date: 11/02/2014 Article note: The ABC trial is registered at www.clinicaltrials.gov as NCT01166438.
Microbiome ; Urinary bacteria ; Urinary urgency incontinence ; Urinary tract infection
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