BackTable / OBGYN / Podcast / Episode #15
with Dr. Ian Fields
In this episode, Dr. Ian Fields joins Dr. Mark Hoffman at the mic to discuss the role of the microbiome in obstetrical and gynecological conditions.
BackTable, LLC (Producer). (2023, February 23). Ep. 15 – The Microbiome [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Ian Fields
Dr. Ian Fields is a urogeyncologist and an assistant professor with OHSU School of Medicine in Portland, Oregon.
Dr. Mark Hoffman
Dr. Mark Hoffman is a minimally invasive gynecologic surgeon at the University of Kentucky.
Dr. Ian Fields completed a fellowship in Female Pelvic Medicine & Reconstructive Surgery and received a Master of Clinical Research degree from Oregon Health & Sciences University. His research focuses on changes in the urinary microbiome and their association with lower urinary tract symptoms.
Dr. Fields begins the episode by describing the microbiome as “all of the things outside of our cells that make up the human body,” which includes bacteria, viruses, and fungi. He explains that the microbiome may play a role in how humans maintain states of health, in addition to having large impacts on the pathophysiology or development of disease states. Dr. Fields references the Human Microbiome Project, a United States National Institutes of Health research initiative that was aimed to improve the understanding of microbiota in relation to human health and diseases.
The physicians then transition to cover the role of the microbiome, specifically in the field of obstetrics and gynecology. Dr. Fields explains that the most studied condition is bacterial vaginosis. From a urogynecology perspective, he expresses a particular interest in urinary tract disorders, such as urinary incontinence, recurrent urinary tract infections, and interstitial cystitis. Dr. Fields emphasizes to listeners that urine is not sterile. In addition, he highlights how the use of vaginal estrogen increases the presence of lactobacillus within the genital microbiome, and thus is beneficial in the settings of genitourinary syndrome of menopause and recurrent menopause.
Dr. Fields concludes the episode by briefly addressing other areas of study regarding the microbiome in the field of obstetrics and gynecology. For example, studies have revealed a link between vaginal microbiota and risk of preterm birth, as well as neonatal gut microbiota and the mode of delivery. Ultimately, Dr. Fields states that the microbiome is an underfunded and understudied aspect of medicine, and he urges listeners to acknowledge the large potential the field has.
The Human Microbiome Project:
Brubaker L, Nager CW, Richter HE, Visco A, Nygaard I, Barber MD, Schaffer J, Meikle S, Wallace D, Shibata N, Wolfe AJ. Urinary bacteria in adult women with urgency urinary incontinence. Int Urogynecol J. 2014 Sep;25(9):1179-84.
Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, Mueller ER, Schreckenberger P, Dong Q, Nelson DE, Brubaker L. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012 Apr;50(4):1376-83.
Hoffman C, Siddiqui NY, Fields I, Gregory WT, Simon HM, Mooney MA, Wolfe AJ, Karstens L. Species-Level Resolution of Female Bladder Microbiota from 16S rRNA Amplicon Sequencing. mSystems. 2021 Oct 26;6(5):e0051821.
Richter HE, Carnes MU, Komesu YM, Lukacz ES, Arya L, Bradley M, Rogers RG, Sung VW, Siddiqui NY, Carper B, Mazloomdoost D, Dinwiddie D, Gantz MG; Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Association between the urogenital microbiome and surgical treatment response in women undergoing midurethral sling operation for mixed urinary incontinence. Am J Obstet Gynecol. 2022 Jan;226(1):93.e1-93.e15.
Fettweis, J.M., Serrano, M.G., Brooks, J.P. et al. The vaginal microbiome and preterm birth. Nat Med 25, 1012–1021 (2019).
[Dr. Mark Hoffman]
What are ways that we think the microbiome is impacting disease processes and the urinary tracts of our patients?
[Dr. Ian Fields]
A lot of work has really been done specifically in urinary incontinence, so both the types of incontinence that I see as a urogynecologist, stress incontinence, which is leakage of urine that happens with activities like cough, laugh, sneeze, exercise, things like that, and urgency urinary incontinence, which is really a lot well less understood how that happens.
I think we can see how stress incontinence happens typically because of pregnancy, childbirth, you lose support of the urethra, therefore, activities that increase intra-abdominal pressure like cough, laugh, and sneeze could potentially lead to loss of urine involuntarily.
[Dr. Mark Hoffman]
That seems more of a functional thing. When you said you thought the microbiome had a role with stress incontinence, I was like, "I thought we understood that, because it was pelvic floor stuff and now you're saying there's like more to the story.
[Dr. Ian Fields]
There is, there is. When we think of stress incontinence specifically, a lot of the work has been done about response to surgery, and there was this large trial that was just presented and published I believe in the GREY Journal within the last year or so showing that the presence of different bacteria in the bladder at the time of surgery or before surgery could predict somebody's response to mid-urethral sling surgery. It was down to a couple different genera of bacteria that when present may potentially lead somebody to not respond as well to mid-urethral sling surgery.
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