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Sources of Funding: Funded by a Urology Care Foundation Grant (ALA) and the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Network (1U01DK103260; JTA, JK, MRF)

Introduction

To investigate the influence of host-microbe interactions on lower urinary tract symptoms, we characterized changes in urinary fungal communities (the “mycobiome�) associated with urinary urgency and bladder pain. While alterations in the urinary bacterial microbiome are found in interstitial cystitis/bladder pain syndrome (IC/PBS) and overactive bladder (OAB), urinary fungal populations have remained completely uncharacterized, despite recent evidence implicating fungi in association with flare in chronic pelvic pain syndromes.

Methods

Catheterized urine specimens were obtained from IC/PBS (n=12), OAB (n=17), and asymptomatic patients (n=14). After centrifugation, DNA was extracted from the cellular pellet. Following deep sequencing of the ITS1 fungal ribosomal gene, fungal taxa were identified by comparison to multiple fungal sequence databases. Using validated questionnaire data [the Genitourinary Pain Index (GUPI), OAB Questionnaire (OABq) and O’Leary-Sant Indices (ICSI/ICPI)], subjects were separated into tertiles based on symptomatic scores. Fungal community representation for each tertile was then examined while blinding for diagnosis.

Results

Comparison of microbial communities between the subjects with the lowest and highest scores on the GUPI, OABq, and ICSI/ICPI revealed decreased fungal diversity for patients with more severe symptoms, regardless of symptom type. Individual symptoms were associated with distinctive species profiles, regardless of diagnosis (Figure). Patients with severe bladder pain exhibited altered Malassezia spp. composition, while fear of leakage was inversely correlated with detectable Wickerhamomyces spp.

Conclusions

The urinary mycobiome is altered in lower urinary tract symptoms, with loss of diversity correlating positively with symptom severity. Specific fungal community patterns correlated independently with painful bladder and urinary urgency symptoms. These results suggest the intriguing possibility that particular microbial patterns may be associated with specific symptoms, not necessarily diagnoses, which has important implications for future studies of the urinary tract microbiome and the development of diagnostic and treatment algorithms in LUTS.

Funding

Funded by a Urology Care Foundation Grant (ALA) and the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Network (1U01DK103260; JTA, JK, MRF)