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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; JK, JCN, GSE, MRF, JTA)

Introduction

Despite historical assumptions that urine is sterile, accumulating research demonstrates that adult women have diverse bacterial ecosystems resident in the urine. Changes in these communities are associated with benign lower urinary tract conditions, such as overactive bladder (OAB) and interstitial cystitis/painful bladder syndrome (IC/PBS). As there is significant symptomatic overlap between these two conditions, we sought to characterize changes in the urinary microbiome in a spectrum of patients with these bladder hypersensitivity syndromes to clarify potential shared pathophysiologic mechanisms.

Methods

We used high-throughput 16S rRNA gene sequencing using an Illumina MiSeq next generation sequencing platform to identify bacterial DNA isolated from catheterized urine specimens obtained from asymptomatic controls (n=14) and subjects with IC/PBS (n=13) or OAB (n=17). After classifying bacterial taxa via alignment to multiple bacterial 16S sequence databases, urinary communities were compared at a population level between experimental groups.

Results

Women with OAB or IC/PBS demonstrated decreased bacterial diversity at the genus level in comparison to controls, but this difference was more profound in IC/PBS (Figure). Several unique genera were altered in these conditions in comparison to controls. Changes in the levels of Burkholderia, a genus recently identified in association with chronic pelvic pain in males (Nickel et al., 2015), were associated with disease in our population, with a stronger association with OAB than IC/PBS. In addition, alterations in Lactobacillus species were also prevalent in both conditions, but more pronounced in patients with IC/PBS.

Conclusions

Bacterial communities resident within the lower urinary tract are altered in the presence of lower urinary tract symptoms. The microbiomes of urine from patients with OAB and IC/PBS, however, were similar when analyzed in parallel, varying more with symptom severity than with diagnosis. Regardless of diagnosis, greater symptom severity inversely correlated with bacterial diversity. These results support recent propositions that OAB and IC/PBS may represent points on a spectrum of disease sharing a similar pathophysiology.

Funding

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