Effects of Intravesical Lactobacillus Rhamnosus GG on Urinary Symptom Burden in People with Neurogenic Lower Urinary...

Area of Science:

• Urology
• Microbiology
• Neuroscience

Background:

• Neurogenic lower urinary tract dysfunction (NLUTD) significantly impacts individuals with spinal cord injury and disease (SCI/D).
• Management often involves intermittent catheterization (IC), which can be associated with urinary symptoms.
• Current treatments may not fully address symptom burden, necessitating novel therapeutic approaches.

Purpose of the Study:

• To evaluate the efficacy of intravesical Lactobacillus rhamnosus GG (LGG) in alleviating urinary symptoms in individuals with SCI/D and NLUTD using IC.
• To assess the impact of LGG on symptom burden as measured by the Urinary Symptom Questionnaire for Neurogenic Bladder-IC version (USQNB-IC).

Main Methods:

• A three-phase, 6-month study (baseline, intervention, washout) involving 96 adults and 7 children with SCI/D nationwide (United States).
• Participants followed the Self-Management Protocol using Probiotics (SMP-Pro), self-administering intravesical LGG+ Normal Saline when specific urinary symptoms (cloudy or foul-smelling urine) occurred.
• Symptom burden was assessed weekly using the USQNB-IC, with changes analyzed between phases.

Main Results:

• Participants instilled LGG an average of 3.83 times during the intervention phase.
• A significant improvement in the burden of clinically actionable (Type A) and urine quality (Type B2) symptoms was observed during the washout phase for those who instilled LGG.
• No symptom improvement was noted in participants who did not instill LGG.

Conclusions:

• Self-administered intravesical Lactobacillus rhamnosus GG appears to be effective in reducing specific urinary symptom burdens (clinically actionable and urine quality) in individuals with SCI/D and NLUTD.
• The Self-Management Protocol using Probiotics (SMP-Pro) provides a feasible method for self-administration.
• This first-in-human trial provides a foundation for further investigation into intravesical LGG as a therapeutic option for neurogenic bladder symptoms.