Richter HE, Carnes MU, Komesu YM, et al. - Researchers examined the correlation of the preoperative urinary and vaginal microbiomes with treatment response 12-months after mid-urethral sling surgery in women with mixed urinary incontinence. In a subset of women undergoing mid-urethral sling surgery in the ESTEEM (Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence) trial (NCT01959347), preoperative microbiome compositions of urine and vaginal samples were compared between women who were surgical responders and surgical non-responders. Greater vaginal Lactobacillus were detected at the time of surgery in women meeting a 70% reduction of urinary incontinence treatment episodes (objective responders), however this association diminished after controlling for age. Greater vaginal Prevotella was detected at the time of mid-urethral sling surgery in women not meeting a 70% reduction of urinary incontinence episodes 1 year after mid-urethral sling surgery. Further research is required to assess if therapy altering the vaginal microbiome may influence surgical treatment response in these women.