Division of Urogynecology, Brigham and Women's Hospital, 500 Brookline Ave, Suite E, Boston, MA, 02115, USA.
Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland.
Int Urogynecol J. 2023 Dec;34(12):3041-3050. doi: 10.1007/s00192-023-05664-5. Epub 2023 Oct 14.
Studies within the past decade have suggested associations among composition of the urinary microbiota, local immune responses, and urinary incontinence symptoms. To investigate these relationships, we evaluated the structure of the urinary microbiome, local inflammatory markers, and patient responses prior to and at 6-weeks after treatment with anticholinergic medication for urgency urinary incontinence (UUI).
Using a prospective pilot study, we enrolled women who presented with UUI symptoms and were prescribed treatment with anticholinergics. Catheterized urine samples were collected from participants at their baseline and 6-week follow-up visits for microbiological (standard and 16S rRNA gene phylotyping analyses) and cytokine analysis along with the UDI-6 questionnaire and 2-day bladder diary.
Patients were Caucasian, post- menopausal, with a median age of 64 and median BMI of 30.1 kg/m. Among the patients, 75% had UUI symptoms for less than 2 years, but with a frequency of at least a few times a week or every day. Most women were prescribed 10 mg oxybutynin ER daily at enrollment. Patients had varied urinary microbiota by culture and 16S phylotyping, with species of Lactobacillus being the most common, in six samples, in addition to taxa associated with Enterococcus, Staphylococcus, and mixed flora. Cytokine levels showed no differences before and after treatment with anticholinergics, nor correlation with urinary bacteria or microbiome composition.
Our pilot study suggests factors in addition to the urinary microbiome and local immune responses may be involved in patients' response to anticholinergics for UUI.
在过去十年的研究中，人们发现尿液微生物群组成、局部免疫反应与尿失禁症状之间存在关联。为了研究这些关系，我们评估了急迫性尿失禁（UUI）患者在接受抗胆碱能药物治疗前和治疗 6 周后的尿液微生物组结构、局部炎症标志物和患者反应。
我们采用前瞻性试点研究，招募了患有 UUI 症状并接受抗胆碱能药物治疗的女性患者。参与者在基线和 6 周随访时采集了导尿尿液样本，用于微生物学（标准和 16S rRNA 基因分形分析）和细胞因子分析，以及 UDI-6 问卷和 2 天膀胱日记。
患者为白种人，绝经后，中位年龄 64 岁，BMI 中位数为 30.1 kg/m。患者中，75%的 UUI 症状持续时间不足 2 年，但每周至少有几次或每天都有症状。大多数女性在入组时每日服用 10mg 奥昔布宁 ER。患者的尿液微生物群通过培养和 16S 分形分析存在差异，除了与肠球菌、葡萄球菌和混合菌群相关的分类群外，乳酸杆菌是最常见的六种样本中的一种。抗胆碱能药物治疗前后细胞因子水平无差异，与尿液细菌或微生物组组成也无相关性。
我们的初步研究表明，除了尿液微生物群和局部免疫反应之外，患者对 UUI 抗胆碱能药物的反应可能还涉及其他因素。
