Sacral Neuromodulation and the Microbiome in women with Urgency Urinary Incontinence

One in four women reports bothersome symptoms of a pelvic floor disorder with 16% reporting urinary incontinence (UI)1. Sacral neuromodulation (SNM) which is approved for men and women with urgency urinary incontinence, urgency frequency syndrome, urinary retention and anal incontinence, is a procedure designed to deliver electrical pulses to the sacral nerves, thereby influencing the bladder, sphincters, and pelvic floor. SNM provides symptomatic relief in 70-86% of patients undergoing the procedure for UUI according to several recent prospective studies2-4. Although the success rates are quite good, the precise mechanism of action of SNM in subjects with UUI remains unclear. Moreover, there are little data regarding specific patient characteristics that may serve as “predictors” for success. Recent studies have noted the presence of a urinary microbiota in adult women without clinical urinary tract infections 5-7. Interestingly, the urinary microbiota differs in women with UUI versus women who do not experience UI 8. Likewise, our unit recently discovered the urinary microbiota of women with Interstitial cystitis/Painful bladder syndrome (IC/PBS) differs from age-matched controls without bladder pain (unpublished data). Using the unique urinary microbiome we will explore the urinary microbiome of women undergoing SNM who respond to therapy to the urinary microbiome of women who do not respond. Ultimately, we hope to identify predictors for success in women undergoing SNM for UUI.