MP46-08 URINARY AEROCOCCUS DEFINES A SEVERE, TREATMENT-REFRACTORY PHENOTYPE OF URGE INCONTINENCE IN OLDER WOMEN

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP46)1 Apr 2020MP46-08 URINARY AEROCOCCUS DEFINES A SEVERE, TREATMENT-REFRACTORY PHENOTYPE OF URGE INCONTINENCE IN OLDER WOMEN Paige K Kuhlmann*, MD James E Ackerman, Muhammed Umair Khalique, Ashley Caron, Falisha Kanji, Jennifer T Anger, MD MPH Karyn S Eilber, MD David M Underhill, and A. Lenore AckermanMD PhD Paige K Kuhlmann*Paige K Kuhlmann* More articles by this author , James E AckermanJames E Ackerman More articles by this author , Muhammed Umair KhaliqueMuhammed Umair Khalique More articles by this author , Ashley CaronAshley Caron More articles by this author , Falisha KanjiFalisha Kanji More articles by this author , Jennifer T AngerJennifer T Anger More articles by this author , Karyn S EilberKaryn S Eilber More articles by this author , David M UnderhillDavid M Underhill More articles by this author , and A. Lenore AckermanA. Lenore Ackerman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000901.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND .08OBJECTIVE: Prior microbial analyses have correlated urinary bacteria (the urinary “microbiota”) with urgency urinary incontinence (UUI) severity, implicating several bacterial taxa such as Aerococcus, an emerging uropathogen. We characterized the urinary microbiome of patients with overactive bladder (OAB) to identify microbial profiles with potential prognostic relevance. METHODS: Catheterized urine samples from 74 post-menopausal women were evaluated by 16S next-generation sequencing (NGS) for bacterial community profiling. Unsupervised k means clustering analysis of NGS data identified population subsets with unique microbial profiles. Quantitative PCR detecting Aerococcus spp. validated NGS results, defining a diagnostic threshold for inclusion in the Aerococcus-positive subtype. Chart review collected data on subject symptoms and responses to therapies. RESULTS: NGS profiling of urine (45 UUI and 29 controls) revealed community patterns in urinary microbiota (urotypes) that segregated with the presence and severity of UUI. Severe UUI was seen in three urotypes: two were diverse communities dominated by Corynebacterium or Prevotella (Mixed), while a third exhibited a homogeneous microbiota dominated by Aerococcus. The phenotypes of Mixed UUI subjects did not differ in symptom severity from the Aerococcus group, although the latter had more bladder-specific pain. Mixed UUI subjects exhibited at least partial responses to OAB medications, with good responses to intradetrusor botox or bladder instillations, and rarely required other therapies. The Aerococcus urotype responded poorly to most therapies, e.g. vaginal estrogen, anticholinergics, botox, bladder instillations, or neuromodulation. CONCLUSIONS: UUI patients have urinary microbial profiles distinct from asymptomatic controls. Severe UUI patients with abundant Aerococcus are clinically indistinguishable from the Mixed group, but exhibit different responses to existing treatment modalities. The Aerococcus urotype had particularly poor responses to first-line therapies and may benefit from earlier consideration of more aggressive management. Use of our quantitative PCR threshold testing may be helpful for prognostic classification of UUI patients. Source of Funding: SUFU Foundation Chemodenervation Grant © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e676-e676 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paige K Kuhlmann* More articles by this author James E Ackerman More articles by this author Muhammed Umair Khalique More articles by this author Ashley Caron More articles by this author Falisha Kanji More articles by this author Jennifer T Anger More articles by this author Karyn S Eilber More articles by this author David M Underhill More articles by this author A. Lenore Ackerman More articles by this author Expand All Advertisement PDF downloadLoading ...