Hypothesis / aims of study
Urinary tract infections (UTI) are one of the most common problems in patients with neurogenic low urinary tract dysfunction (NLUTD). Reorganization of urinary microbiome in neurogenic bladder plays the important role in UTIs. However, we still do not know how the different types of therapy, particularly, botulinum toxin injections, change the microbiome. The aim was to assess the urinary microbiome in neurogenic bladder patients with high recurrence of UTIs before and after botulinum toxin therapy using 16S rRNA gene (16S rDNA) sequencing and metaproteomics.
Study design, materials and methods
Following written consent, urine samples were obtained from 6 patients with NLUTD due to different neurogenic diseases before intradetrusor botulinum toxin injections and 6 weeks after. Recruited patients had NLUTD for many years, performing intermittent catheterization and suffering from often exacerbations of UTIs. They have undergone an urodynamic study using Triton (Laborie) machine with air-charged catheters. The presence of high-pressure detrusor overactivity had been proven in all patients. Previous therapy with anticholinergics had had no effect.
Injections of 200 Units (UI) of onabotulinumtoxin A (Botox, Allergan) where performed in operation room under intravenous aesthesia directly in the detrusor in 20 points (10UI/point) with cystoscope and end endoscopic needle (injeTAK®).
Urine samples where investigated using standart urinalysis, enhanced quantitative urine culture (EQUC) method and 16S rRNA gene (16S rDNA) sequencing.
Interpretation of results
Patients with NLUTD have modified microbiome with the prevalence of Enterobacterales. The study showed that in females improving in urodynamic parameters after botulinum toxin injections may be associated with changing in the urine microbiome towards a normal flora. It expands our understandig of the UTIs development in patients with neurogenic bladder and the protective effect of the botulinum toxin therapy.