The relationship of the microbiota of the distal urethra with irritative symptoms of the lower urinary tract in patients with benign prostatic hyperplasia

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Abstract
BACKGROUND: The microbiota of the male urethra, as an organ of the lower urinary tract affects the pathogenesis of benign prostatic hyperplasia (BPH). However, the specifics of the relationship between composition of the urethral microbiota and irritative symptoms of the lower urinary tract are still poorly understood. AIM: To evaluate the relationship between the composition of the microbiota of the distal urethra and the presence of irritative symptoms from symptoms of the lower urinary tract in BPH. METHODS: The patients included in the study ( n = 64) were divided into two groups: group 1 (main, n = 44, patients with clinical signs of BPH) and group 2 (comparison, n = 20, conditionally healthy men). All men underwent an International Prostate Symptom Score (IPSS) assessment of symptoms with a sub-score of irritative symptoms. The composition of the urethral microbiota was studied by sequencing of the 16S ribosomal RNA gene. Statistical analysis was carried out using the Mann–Whitney criteria, with calculation of the Pearson correlation coefficient ( r ), Student’s t -test, regression models and significance level ( p ). RESULTS: In patients with BPH, the microbiota of the urethra was found to be dominated by anaerobic taxa: the order Peptostreptococcales-Tissierellales and the families Corynebacteriaceae , Streptococcaceae , and Staphylococcaceae . In the comparison group, the urethral microbiome was represented by the families Peptoniphilaceae , Acetobacteraceae and Bacteroidaceae . A direct correlation was found between the presence of the Enterobacteriaceae family ( r = 0.56, p = 0.05) and the severity of irritative symptoms of BPH. CONCLUSION: In patients with BPH, a distinctive composition of the urethral microbiota is formed, characterized by an increase in the proportion of opportunistic anaerobes and skin commensals. The revealed association of the presence of Enterobacteriaceae in the urethra with the severity of irritative symptoms allows us to consider urethral dysbiosis as a new potential pathogenetic factor for irritative symptoms in BPH.

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