The Role of Urinary Microbiome Analysis in the Diagnostic Approach and Management of Urinary Incontinence: A Systematic Review.

Urinary incontinence (UI) is a significant global health issue that impacts mainly middle-aged women, severely affecting their quality of life. Emerging research highlights the urinary microbiome's complex role in the etiology and management of UI, with microbial dysbiosis potentially influencing symptom severity and treatment outcomes. This systematic review aimed to evaluate the current evidence on the urinary microbiome's role in diagnosing and managing UI, focusing on variations in microbial composition across UI subtypes. We identified 21 studies, mostly employing 16S rRNA sequencing to characterize urinary microbiota and their associations with various UI subtypes, including urgency urinary incontinence (UUI), overactive bladder (OAB), and stress urinary incontinence (SUI). The findings revealed distinct microbial patterns, such as reduced Lactobacillus levels and increased Gardnerella prevalence, particularly in UUI. Altered microbiome profiles correlated with symptom severity, with reduced Lactobacilli suggesting a protective role in maintaining urinary health. Specific microbial species, including Actinotignum schaalii and Aerococcus urinae, emerged as potential biomarkers for UI diagnosis. Despite promising findings, limitations such as small sample sizes, variability in microbiome profiling methods, and insufficient causal evidence underscore the need for further research.