Resilience of the Urogenital Microbiota Following Urogynecologic Surgery

IMPORTANCE: Little is known about the resilience of the urogenital microbiota in response to urogynecologic surgery.

OBJECTIVES: The aim of this study was to determine if the urogenital microbiota are disrupted after surgery and if the postoperative composition returns to a preoperative baseline. We also sought to determine if the process of recovery differs in premenopausal women versus postmenopausal women.

STUDY DESIGN: Women undergoing surgery for pelvic floor disorders were invited to participate in this longitudinal descriptive study. Catheterized urine specimens and vaginal swabs were obtained at 4 timepoints: (1) day of surgery prior to antibiotic administration and surgical preparation; (2) immediately postoperatively; (3) 3-week postoperative visit; and (4) 12-week postoperative visit. Bacterial DNA was extracted, sequenced by 16S rRNA gene sequencing and classified taxonomically. Longitudinal data analyses were performed using linear mixed-effects models evaluating Jensen-Shannon divergence and α diversity measures.

RESULTS: Forty women, 50% of whom were postmenopausal, were included. There were significant alterations in α diversity over time (P time ≤0.05 for all comparisons), except richness in the bladder. There was perturbation immediately postoperatively, with a return to preoperative baseline at 3 and 12 weeks postoperatively. At each timepoint, premenopausal participant microbiota were not diverse, whereas postmenopausal women had diverse compositions. Jensen-Shannon divergence indices were stable in both the bladder (P = 0.95) and vagina (P = 0.88) over time in premenopausal women but showed divergence from the preoperative vagina for postmenopausal women (P = 0.004).

CONCLUSIONS: The urogenital microbiome is altered after urogynecologic surgery. In premenopausal versus postmenopausal women, the composition, stability, and process of recovery differ.