Figure 6.

Increasing UUI symptom severity is associated with decreased microbial diversity in women with UUI. We identified relationships between the richness and evenness of the urinary microbiome (as measured by the Inverse Simpson and Shannon indices, where lower scores are indicative of lower microbial diversity) and UUI symptom severity. The percent of incontinent episodes is measured by percent of voids with an USS score equal to 4 on a 3 day bladder dairy, and an increase indicates more incontinent episodes. The urogenital distress inventory is a validated questionnaire measuring symptom distress from incontinence and a higher score indicates more distress. Both of these measures have a significant negative correlation with microbial diversity. The OABq-symptom bother is the health related quality of life score from the validated overactive bladder questionnaire. A higher score indicates less symptom bother and is positively correlated with diversity measures. Together, these data indicate that a reduction in microbial diversity is associated with an increase in symptom severity.