{"id":1138,"date":"2025-03-10T13:22:59","date_gmt":"2025-03-10T13:22:59","guid":{"rendered":"https:\/\/urolistic.com\/?p=1138"},"modified":"2025-05-27T08:08:09","modified_gmt":"2025-05-27T08:08:09","slug":"la-microbiota-urogenital","status":"publish","type":"post","link":"https:\/\/urolistic.com\/fr\/blog\/2025\/03\/10\/la-microbiota-urogenital\/","title":{"rendered":"Le microbiote urog\u00e9nital"},"content":{"rendered":"
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Le microbiote est l'ensemble des micro-organismes qui peuplent tous les tissus sains de notre corps. Depuis sa description par Albert D\u00f6derlein en 1891, on conna\u00eet l'existence d'une \"flore vaginale\" ou \"flore de D\u00f6derlein\", compos\u00e9e principalement de bact\u00e9ries du genre\u00a0Lactobacillus<\/em>produisant de l\u2019acide lactique, comme l\u2019acide qu\u2019on retrouve dans le yaourt. Aujourd'hui, nous savons que tous nos tissus et fluides sont habit\u00e9s par des micro-organismes, m\u00eame ceux qui \u00e9taient consid\u00e9r\u00e9s comme \"st\u00e9riles\" jusqu'\u00e0 r\u00e9cemment, comme le placenta, le liquide amniotique, l'urine ou le syst\u00e8me nerveux.<\/p>\n\n

Qu'est-ce que le microbiote urog\u00e9nital ?<\/h3>\n\n

Jusqu'\u00e0 r\u00e9cemment, on pensait que l'urine \u00e9tait st\u00e9rile et que des bact\u00e9ries et d'autres germes ne colonisaient les voies urinaires que lorsqu\u2019il y avait une infection. Aujourd'hui, gr\u00e2ce \u00e0 la biologie mol\u00e9culaire et aux techniques d'amplification g\u00e9nomique qui permettent de d\u00e9tecter des micro-organismes qui ne poussent pas dans les milieux de culture classiques, on sait qu'il existe un microbiote tr\u00e8s vari\u00e9 au niveau urinaire, et qu'il n'est pas le m\u00eame que le microbiote g\u00e9nital. Cependant, si le syst\u00e8me urinaire et le syst\u00e8me g\u00e9nital f\u00e9minin ne partagent pas le m\u00eame microbiote, la composition de l'un peut \u00eatre influenc\u00e9e par la composition de l'autre.<\/p>\n\n

Dans le cas du microbiote vaginal, six \"vaginotypes\" ont \u00e9t\u00e9 d\u00e9crits, en fonction de la pr\u00e9dominance de certains micro-organismes. Je n'entrerai pas dans une description d\u00e9taill\u00e9e de ces vaginotypes, mais il est important de noter que, selon le type de germe pr\u00e9dominant, il y aura une production plus ou moins importante d'acide lactique, qui r\u00e9gulera le pH vaginal et, par cons\u00e9quent, les micro-organismes qui y r\u00e9sideront. Plus l'acidit\u00e9 est \u00e9lev\u00e9e, plus le risque de colonisation vaginale par des germes uropathog\u00e8nes, qui ne supportent pas un pH tr\u00e8s bas, est faible. C'est pourquoi les femmes de vaginotype I, o\u00f9 le\u00a0Lactobacillus crispatus<\/em>est le micro-organisme pr\u00e9dominant, et qui a la plus forte production d'acide lactique et donc le pH le plus acide (environ 4), est le groupe de femmes ayant la plus faible pr\u00e9valence d'infections urinaires et de maladies virales sexuellement transmissibles. \u00c0 l'oppos\u00e9, on trouve le vaginotype IVb, compos\u00e9 principalement de bact\u00e9ries non lactobacillaires, et dont le pH avoisine les 5,3. Ce pH plus \u00e9lev\u00e9 pr\u00e9dispose aux infections urinaires, aux maladies sexuellement transmissibles et aux infections vaginales (vaginose).\u00a0<\/p>\n\n

Il faut \u00e9galement noter que la composition du microbiote vaginal change au cours de la vie d'une femme, en fonction de son statut hormonal. L'\u00e9paisseur de la muqueuse vaginale, sa teneur en glycog\u00e8ne (sucre) et les cycles menstruels influencent le type de germes qui pr\u00e9dominent \u00e0 un moment donn\u00e9, car les lactobacilles se nourrissent des cellules qui se d\u00e9tachent de la paroi vaginale et du glycog\u00e8ne qu'elles contiennent. C'est pourquoi l'incidence des cystites augmente avec l'\u00e2ge, surtout apr\u00e8s la m\u00e9nopause, car l'absence d'\u0153strog\u00e8nes (hormones f\u00e9minines) favorise l'amincissement de la paroi vaginale et fait que les cellules sont moins charg\u00e9es en glycog\u00e8ne. Moins nourries, la concentration de lactobacilles diminue et, par cons\u00e9quent, la production d'acide lactique. C'est pourquoi l'application de gels hormonaux dans le vagin, qui am\u00e9liorent l'\u00e9tat de la paroi vaginale, s'est av\u00e9r\u00e9e \u00eatre une mesure efficace contre les infections urinaires chez les femmes m\u00e9nopaus\u00e9es. Cela permet \u00e9galement de comprendre pourquoi certaines jeunes patientes souffrent souvent d'infections dans les jours pr\u00e9c\u00e9dant la menstruation ou l'ovulation : \u00e0 ces moments-l\u00e0, il y a une forte baisse du taux d'\u0153strog\u00e8nes dans le sang, et donc un amincissement de la paroi vaginale, avec une diminution cons\u00e9quente des lactobacilles vaginaux. La protection contre les germes uropathog\u00e8nes est donc moindre pendant ces jours.\u00a0<\/p>\n\n

\u00a0Outre les changements hormonaux et les modifications du microbiote vaginal, d'autres facteurs peuvent alt\u00e9rer le pH vaginal et favoriser les infections urinaires chez la femme : les rapports sexuels et l'hygi\u00e8ne intravaginale excessive, ainsi que les douches vaginales. Il est tr\u00e8s fr\u00e9quent de rencontrer des patientes qui souffrent d'infections urinaires presque syst\u00e9matiquement apr\u00e8s des rapports sexuels. La faible longueur de l'ur\u00e8tre f\u00e9minin et les \"frottements\" qui se produisent lors des rapports ont toujours \u00e9t\u00e9 incrimin\u00e9s. Mais ce que de nombreuses personnes ignorent, c'est que le sperme est beaucoup plus alcalin que le vagin, avec un pH compris entre 7,2 et 8 en g\u00e9n\u00e9ral, parfois plus. De ce fait, l'\u00e9jaculation intravaginale peut rapidement augmenter le pH et favoriser ainsi le d\u00e9veloppement de bact\u00e9ries uropathog\u00e8nes. De m\u00eame, bien que cela puisse para\u00eetre paradoxal, l'utilisation excessive de savons \u00e0 pH alcalin (qui sont majoritaires) ou de douches vaginales dans la zone g\u00e9nitale peut \u00e9galement modifier l'acidit\u00e9 vaginale et provoquer un d\u00e9s\u00e9quilibre du microbiote vaginal.\u00a0<\/p>\n\n

Quant au microbiote urinaire, il fait l'objet de connaissances de plus en plus \u00e9tendues. On sait par exemple qu'il \u00e9volue avec l'\u00e2ge chez les deux sexes, comme c'est le cas dans le vagin. R\u00e9cemment, sept \"urotypes\" de microbiote f\u00e9minin ont \u00e9t\u00e9 d\u00e9crits, nomm\u00e9s en fonction du genre ou de l\u2019esp\u00e8ce dominante.<\/p>\n\n

Chez l'homme, le microbiote g\u00e9nito-urinaire a \u00e9t\u00e9 beaucoup moins \u00e9tudi\u00e9. Certains micro-organismes communs sont connus, tels que\u00a0Lactobacillus, Sneathia, Veillonella, Corynebacterium, Prevotella,<\/em><\/p>\n\n

Streptocoques\u00a0<\/em>et\u00a0Ureaplasma<\/em>. Ces micro-organismes sont pr\u00e9sents \u00e0 la fois dans l'urine et dans l'ur\u00e8tre. Six urotypes ont \u00e9t\u00e9 r\u00e9cemment d\u00e9crits chez l'homme.<\/p>\n\n

Dans le cas de la prostate, nous trouvons un microbiote quelque peu diff\u00e9rent avec des genres tels que\u00a0Oceanobacillus, Paenibacillus, Streptococcus, Carnobacterium, Alkaliphilus, Cronobacter, Lactococcus, Enterococcus\u00a0<\/em>ou\u00a0Bacillus<\/em>. Le r\u00f4le des diff\u00e9rents micro-organismes qui composent le microbiote urinaire est encore mal connu. Ce qu'il est important de noter, tant chez l'homme que chez la femme, c'est que de nombreux germes que l'on consid\u00e8re comme \"pathog\u00e8nes\", tels que les\u00a0Escherichia<\/em>\u00a0ou\u00a0Streptocoques<\/em>\u00a0peuvent appartenir naturellement au microbiote d'une personne sans provoquer de maladie. D'o\u00f9 l'importance, et je ne me lasserai jamais de le dire, de ne pas traiter les bact\u00e9riuries asymptomatiques.<\/p>\n\n

Bibliographie :<\/em><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Thomas S. D\u00f6derlein\u2019s Bacillus: Lactobacillus acidophilus. The Journal of Infectious Diseases. 1928 Sept. 43(3): 218-227.<\/p>\n

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Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SS, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011 Mar 15;108 Suppl 1(Suppl 1):4680-7.\u00a0<\/p>\n

<\/p>\n

Qin J, Shi X, Xu J, Yuan S, Zheng B, et al. Characterization of the Genitourinary Microbiome of 1,165 Middle-Aged and Elderly Healthy Individuals. Front Microbiol. 2021 Aug 19;12:673969.\u00a0<\/p>\n

<\/p>\n

Pearce MM, Hilt EE, Rosenfeld AB, Zilliox MJ, Thomas-White K, et al. The female urinary microbiome: a comparison of women with and without urgency urinary incontinence. mBio. 2014 Jul 8;5(4):e01283-14.\u00a0<\/p>\n

<\/p>\n

Dong Q, Nelson DE, Toh E, Diao L, Gao X, Fortenberry JD, Van der Pol B. The microbial communities in male first catch urine are highly similar to those in paired urethral swab specimens. PLoS One. 2011;6(5):e19709.\u00a0<\/p>\n

<\/p>\n

Qin J, Shi X, Xu J, Yuan S, Zheng B, et al. Characterization of the Genitourinary Microbiome of 1,165 Middle-Aged and Elderly Healthy Individuals. Front Microbiol. 2021 Aug 19;12:673969.\u00a0<\/p>\n

<\/p>\n

Ma X, Chi C, Fan L, Dong B, Shao X, et al. The Microbiome of Prostate Fluid Is Associated With Prostate Cancer. Front Microbiol. 2019 Jul 19;10:1664.\u00a0<\/p>\n

<\/p>\n

Gottschick C, Deng ZL, Vital M, Masur C, Abels C, et al. The urinary microbiota of men and women and its changes in women during bacterial vaginosis and antibiotic treatment. Microbiome. 2017 Aug 14;5(1):99.\u00a0<\/p>\n

<\/p>\n

Mueller ER, Wolfe AJ, Brubaker L. Female urinary microbiota. Curr Opin Urol. 2017 May;27(3):282-286.\u00a0<\/p>\n

<\/p>\n

Brubaker L, Wolfe A. The urinary microbiota: a paradigm shift for bladder disorders? Curr Opin Obstet Gynecol. 2016 Oct;28(5):407-12.\u00a0<\/p>\n

<\/p>\n

Wu P, Zhang G, Zhao J, Chen J, Chen Y, et al. Profiling the Urinary Microbiota in Male Patients With Bladder Cancer in China. Front Cell Infect Microbiol. 2018 May 31;8:167.\u00a0<\/p>\n

<\/p>\n

Hrbacek J, Morais D, Cermak P, Hanacek V, Zachoval R. Alpha-diversity and microbial community structure of the male urinary microbiota depend on urine sampling method. Sci Rep. 2021 Dec 9;11(1):23758.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

La microbiota es el conjunto de microorganismos que habitan en todos los tejidos sanos de nuestro cuerpo. Desde que fuera descrita por Albert D\u00f6derlein en 1891, [\u2026]<\/span><\/p>\n","protected":false},"author":1,"featured_media":1175,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[],"class_list":["post-1138","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-microbiota"],"yoast_head":"\nLa Microbiota Urogenital | Urolistic<\/title>\n<meta name=\"description\" content=\"Redescubre el bienestar con Urolistic, el proyecto de la Dra. 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