Urinary bacteria differ in women with urinary urgency incontinence versus controls, "Beyond the Abstract," by Alan J. Wolfe

BERKELEY, CA (UroToday.com) - Clinicians have been taught that human urine is sterile. Current evidence confirms that this is incorrect. Recently, our translational team (the Loyola Urinary Education and REsearch Collaboration or LUEREC) used culture-independent approaches (including 16S rRNA sequence analysis) to obtain DNA evidence of bacteria in urine taken directly from the bladders of women without overt clinical UTI - that is, those with negative standard urine cultures.[1, 2] LUEREC then developed an expanded quantitative urine culture (EQUC) protocol that isolates many bacteria that standard culture fails to detect and used EQUC to obtain definitive evidence that female bladders without clinical infection contain live bacteria.[3] Others have obtained similar results.[4, 5]

In this study,[6] we used both methods in a complementary fashion to reveal that the female urinary microbiome (FUM) in women with UUI differs from the FUM of women without UUI. Indeed, some bacterial species, including emerging uropathogens, were strongly associated with UUI. In contrast, one species was associated with the absence of UUI. The implication is that the former species, which are distinct from typical uropathogens, contribute to UUI, whereas the latter species might contribute to bladder health. Our reasoning is supported by one of our earlier studies, which showed that detection of the FUM is associated with increased UUI symptoms, but decreased UTI risk.[2]

The discovery of the FUM has fundamentally changed the current dogma regarding the female urinary tract and related urinary disorders. As we dig deeper to understand specific urinary organisms, individually and as community members, we fully expect further paradigm changes in diagnosis and treatment for women affected by UUI and other lower urinary tract disorders.


  1. Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, Mueller ER, Schreckenberger P, Dong Q, Nelson DE, Brubaker L. , 2012. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol 50(4): 1376-1383.
  2. Brubaker L, Nager C, Richter H, Visco A, Nygaard I, Barber M, Schaffer J, Meikle S, Wallace D, Shibata N, Wolfe AJ. Urinary bacteria in adult women with urgency urinary incontinence. Int Urogynecol J 2014 Feb 11. (Epub ahead of print)
  3. Hilt E, McKinley K, Pearce M, Rosenfeld M, Zilliox M, Mueller E, Brubaker L., Gai, X., Wolfe, AJ, Schreckenberger, PC. 2014. Urine is not sterile: Use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiology 52(3):871-6.
  4. Khasriya R, Sathiananthamoorthy S, Ismail S, Kelsey M, Wilson M, Rohn JL, Malone-Lee J. 2013. Spectrum of bacterial colonization associated with urothelial cells from patients with chronic lower urinary tract symptoms. J Clin Microbiol 51(7):2054-2062.
  5. Fouts DE, Pieper R, Szpakowski S, Pohl H, Knoblach S, Suh MJ, Huang ST, Ljungberg I, Sprague BM, Lucas SK, Torralba M, Nelson KE, Groah SL. 2012. Integrated next-generation sequencing of 16S rDNA and metaproteomics differentiate the healthy urine microbiome from asymptomatic bacteriuria in neuropathic bladder associated with spinal cord injury. Journal of Translational Medicine 10: 174.
  6. Pearce MM, Hilt EE, Rosenfeld AB, Zilliox MJ, Thomas-White K, Kliethermes, S, Schreckenberger PC, Brubaker L, Gai X, Wolfe AJ. 2014. Urinary bacteria differ in women with urinary urgency incontinence versus controls. mBio 5(4) pii: e01283-14

Click HERE to view a related poster from the International Continence Society (ICS) 2014 Annual Meeting 

Written by:
Alan J. Wolfe as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois USA
Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois USA

The female urinary microbiome: A comparison of women with and without urgency urinary incontinence - Abstract

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