The urobiome of continent adult women: a cross-sectional study

T. K. Price, E. E. Hilt, K. Thomas-White, E. R. Mueller, A. J. Wolfe, L. Brubaker

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Objective: To characterise the bladder microbiota of continent adult women. Design: Cross-sectional study of adult women who contributed catheterised urine samples, completed validated symptom questionnaires, and provided demographic data. Setting: US academic medical centre. Population: Well-characterised continent adult women. Methods: Participants contributed symptoms questionnaires, demographic data, and catheterised urine samples that were analysed by enhanced urine culture methodology and 16S rRNA gene sequencing. Main outcome measures: Associations between demographics and microbial community state structures (urotypes, defined by the dominant taxon of each specimen). Results: The bladder microbiota (urobiome) of a control group of 224 continent women were characterised, demonstrating variability in terms of urotype. The most common urotype was Lactobacillus (19%), which did not differ with any demographic. In contrast, the Gardnerella (P < 0.001) and Escherichia (P = 0.005) urotypes were more common in younger and older women, respectively. Conclusions: For urobiome research, enhanced culture methods and/or DNA sequencing are the preferred techniques for bacterial detection. The interpretation of clinical tests, such as the standard urine culture, should incorporate the knowledge that some women have Gardnerella or Escherichia urotypes without evidence of any clinical disorder. Clinical care strategies should preserve or restore the beneficial effects of the native urobiome, as disruption of that microbial community could result in unintended vulnerability to uropathogen invasion or opportunistic pathogen overgrowth. Longitudinal studies of urobiome responses to therapies should be encouraged. Tweetable abstract: In continent adult women bladder microbiome composition differs by age, with relevance for clinical practice.

Original languageEnglish (US)
Pages (from-to)193-201
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number2
StatePublished - Jan 1 2020
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by R01 DK104718, R56 DK104718, R21 DK097435, and P20 DK108268, and by a grant from the Falk Foundation (LU#202567).

Funding Information:
ERM discloses research support from the National Institutes of Health (NIH), Astellas, and Boston Scientific. AJW discloses research support from NIH, Astellas, and Kimberly Clark. LB discloses editorial stipends from Female Pelvic Medicine and Reconstructive Surgery , UpToDate , and JAMA ; she also discloses research funding from NIH. The remaining authors (TKP, EEH, and KTW) report no interests to disclose. Completed disclosure of interests form available to view online as supporting information.

Publisher Copyright:
© 2019 Royal College of Obstetricians and Gynaecologists


  • Bladder health
  • female bladder
  • urinary microbiome
  • urinary microbiota
  • urobiome


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