Login to Access Video or Poster Abstract: MP82-02
Sources of Funding: Funding: Urology Care Foundation Grant (ALA)

Introduction

The urinary bacterial microbiome is altered in overactive bladder (OAB) patients in comparison to controls. As bacteria and fungi frequently have a reciprocal relationship, with fungi expanding and contracting inversely with changes in bacterial burden, we examined if alterations in urinary fungal diversity and community composition accompany these bacterial changes to play a role in OAB pathophysiology.

Methods

Urinary fungal and bacterial burdens were examined by quantitative polymerase chain reaction of conserved ribosomal RNA (rRNA) regions. Individual bacterial and fungal species were identified using deep sequencing of the 16S and ITS1 loci, respectively, of genomic DNA from catheterized urine obtained from asymptomatic controls (n=14) and OAB patients (n=17). Bacterial and fungal taxa were identified by alignment to multiple sequence databases. The relative abundances of individual species, overall microbial diversity, and total microbial burdens for each urinary microbial community were compared between OAB and controls and correlated with self-reported symptom severity as measured by the OAB questionnaire (OABq).

Results

OAB was associated with significantly decreased fungal burden, with a nonsignificant increase in overall bacteria. Bacterial community composition at both the species and genus level was not significantly different between OAB patients and healthy controls. In contrast, overall fungal levels were dramatically decreased in OAB, which correlated with a drastically altered mycobiome. Worsening symptom severity (assessed by OABq) was associated with loss of Cladosporium spp. and Malassezia sympodialis and dramatic expansion of Wickerhamomyces anomalus.

Conclusions

While minimal differences could be observed in urinary bacterial communities, overactive bladder was associated with major shifts in urinary fungi, both in overall levels and community composition and diversity. The observation that the loss of urinary fungi is associated with urinary tract symptomatology suggests a crucial role for fungi in bladder homeostasis and implicates several fungal species, such as Wickerhamomyces, as possible pathobionts in the urinary tract.

Funding

Funding: Urology Care Foundation Grant (ALA)