Through its intramural and extramural organizational units, the NICHD supports and conducts research on urinary tract health. Short descriptions of this research appear below.
Institute Activities and Advances
The NICHD's research efforts focus on the diagnosis and prevention of urinary tract infections (UTIs) and urinary incontinence (UI).
The Gynecologic Health and Disease Branch (GHDB)
funds research on pelvic floor disorders (PFDs). These occur when the muscles and connective tissues of the pelvic area weaken or are injured and include UI. Branch research on UI is:
- Evaluating the effectiveness of a new treatment for urge UI, myofascial physical therapy, which aims to release tension in muscle tissue. Myofascial therapy is commonly used to relieve soft tissue restrictions that cause pain.
- Investigating how incontinence develops after vaginal delivery to develop and test treatments and prevention methods for stress UI
- Determining the potential of stem cell therapy to increase elastin content of lower urinary tract tissues, which could facilitate recovery after vaginal delivery and prevent UI
Researchers also are examining the impact of obesity on UTIs. They have found that elevated body mass index (BMI) increases the risk for UTI and pyelonephritis, a kidney infection caused by bacteria traveling to the kidney from the bladder. Their results can help guide weight loss treatment to prevent UTIs, but more studies are needed to determine a causal relationship between obesity and UTI. (Source: Semins, M. J., Shore, A. D, Makary, M. A, Weiner, J., Matlaga, B. R. (2012). The impact of obesity on urinary tract infection risk. Urology, 79: 266-–269. PMID: 22130358)
In addition, the Section on Epigenetics and Development, part of the Division of Intramural Research (DIR), conducts research that includes the study of girls and women with Turner Syndrome (TS), a condition in which a female is partially or completely missing an X chromosome. Congenital malformations of the urinary tract are found in up to 30% of patients with TS. Many of these abnormalities are not clinically significant, but some may result in increased risk of UTIs.
The NICHD participated in a consensus workshop to develop recommendations for diagnosing and managing TS. The resulting recommendations of an independent panel of experts called for patients to be evaluated for renal abnormalities after receiving a TS diagnosis. Women found to have such abnormalities should then receive a renal ultrasound study and urine culture every 3 to 5 years. They may also need to be screened for UTIs more often. (Source: Saenger, P., Wikland, K. A., Conway, G. S., Davenport, M., Gravholt, C. H., Hintz, R., et al. (2001). Recommendations for the diagnosis and management of Turner syndrome. Journal of Clinical Endocrinology & Metabolism, 86: 3061–3069. PMID: 11443168)
The Spinal Cord and Musculoskeletal Disorders and Assistive Devices (SMAD) Program, part of the NICHD’s National Center for Medical Rehabilitation Research, is studying individuals with neurogenic bladder after spinal cord injuries (SCI) and recurrent UTIs in these patients. In one SMAD Program-supported project, researchers seeded the bladder with benign bacteria (Escherichia coli HU2117) to out-compete pathogenic strains and prevent their growth. Follow-up studies are ongoing, but preliminary results show that the E. coli safely reduces the risk of UTI in patients with SCI. (Source: Darouiche, R. O., et al. (2011). Multicenter randomized controlled trial of bacterial interference for prevention of urinary tract infection in patients with neurogenic bladder. Urology, Aug;78(2):341-6. PMID: 21683991)
Other Activities and Advances
- The NICHD also supports research on UI through the Pelvic Floor Disorders Network (PFDN), which was established in 2001 to encourage collaborative research on PFDs and to improve patient care. PFDN research has advanced understanding of the prevalence and epidemiology of PFDs and risk factors for the disorders, and it has informed clinicians regarding diagnosis and treatment methods. For example:
- The Ambulatory Treatments for Leakage Associated with Stress (ATLAS) study, a randomized controlled trial of nonsurgical treatment for stress urinary incontinence, provided information on the relative efficacy of (and satisfaction with) pessaries, training and exercise of the pelvic floor muscles, and the two treatments combined.
- The Colpopexy and Urinary Reduction Efforts (CARE) and Outcomes Following Vaginal Prolapse Repair and Mid Urethral Sling (OPUS) studies evaluated the addition of a procedure used to treat stress incontinence at the time of surgery for pelvic organ prolapse in women without symptoms of stress incontinence. The studies found that the procedure helped prevent stress incontinence after surgery.
- The Anticholinergic vs. Botox Comparison Study (ABC) was a double-blind, double-placebo-controlled randomized trial that provided much-need data comparing these two commonly prescribed treatments for urgency urinary incontinence. The trial found that the medications equally reduced the frequency of daily urinary incontinence but had different side effect profiles. A journal article describing these findings can be found at: http://www.ncbi.nlm.nih.gov/pubmed/23036134 (In January, 2013, the FDA expanded the approved use of Botox to include adults who do not respond to anticholinergics for overactive bladder. News release: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm336101.htm)
- In addition, the NICHD launched the Urinary Incontinence Treatment Network with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in 1999. Through the network, collaborating researchers have conducted clinical trials and other long-term studies of surgical, pharmacological, and behavioral approaches for managing UI in women with stress and mixed incontinence. The NICHD does not fund the Network at this time.
- In 2010, the NICHD sponsored the 2-day workshop on Pregnancy in Women with Disabilities to review the current body of evidence on the management of pregnancy in women with physical disabilities. The Workshop identified key gaps in knowledge and recommendations for priority avenues for future research and included a discussion of UTIs as a common complication of such pregnancies. For example, according to scientists who took part in the workshop, 46% of women with spinal cord injuries develop UTIs during pregnancy. Broad-spectrum antibiotics appear to provide effective treatment, but some questions about prevention techniques remain unresolved. A journal article that resulted from the workshop is available at http://www.ncbi.nlm.nih.gov/pubmed/21422868.
- Evidence about the treatment of UTIs in preterm and low birth weight infants was also evaluated as part of a 2010 Cochrane Review supported by the NICHD. The study specifically examined treatments to compensate for the underdeveloped immune systems of preterm infants and low birth weight infants as a way to prevent infection.
- The NIDDK also maintains information regarding a 2001 conference convened to evaluate the research agenda for UTI, UI, and other pelvic conditions. Read more about the Bladder Research Progress Review Group.