J. Curtis Nickel, MD, FRCSC

In the second lecture of a three-part foundational series for Grand Rounds in Urology’s Next Generation Microbiome and Urologic Infections Learning Center, J. Curtis Nickel, MD, FRCSC, Professor of Urology at Queen’s University in Ontario, Canada, discusses how changes to the urinary microbiome, which he previously described as helping maintain urinary health, can contribute to the development of urinary disease. Dr. Nickel summarizes the findings of several studies that evaluate the impact of the microbiome on urologic chronic pelvic pain, observing that dysbiosis appears to be more important than any particular bacterium in the development of chronic prostatitis/chronic pelvic pain syndrome, female bladder pain, and female lower urinary tract symptoms (LUTS), although researchers have identified some candidate organisms. Dr. Nickel notes that the development of struvite stones and calcium oxalate stones are also associated with dysbiosis. He concludes by discussing the role of bacteria in urinary cancers, explaining that distinct microbiome patterns appear to be related to certain responses to bladder cancer, and that prostate cancer is often associated with prostate inflammation caused by bacterial infection, although the role of the microbiome in prostate cancer development has yet to be determined.

In the first lecture in a three-part foundational series for Grand Rounds in Urology’s Next Generation Microbiome and Urologic Infections Learning Center, J. Curtis Nickel, MD, FRCSC, discusses the urology community’s evolving understanding of the urinary microbiome’s role in promoting urinary health. He observes that while doctors have recognized the importance of the gut microbiome for some time, most urologists held the traditional belief that the urinary tract was sterile until the past decade. However, with next-generation sequencing, researchers have rapidly discovered that the urinary tract is a “veritable microbial jungle” that is home to more than 4,000 species. Now that researchers are aware of its existence, Dr. Nickel emphasizes that it is necessary to study the normal urinary microbiome in order to better understand the changes that might result in dysbiosis and disease, discussing the results of past small studies as well as the potential of his team’s recently-initiated, 600-subject ongoing normal microbiome study.

J. Curtis Nickel, MD, FRCSC, Professor of Urology and Research Chair in Urologic Pain and Inflammation at Kingston General Hospital Kingston, Ontario, Canada, discusses the relationship between the prostate microbiome and prostate cancer. He goes on to discuss the intricacies of the prostate microbiome, the pitfalls of attributing inflammation and prostatitis to prostate cancer pathogenesis, as well as the impact next-generation sequencing (NGS) has on improving the identification of the microbiome within the prostate. Finally, he summarizes the association of the prostate microbiome to prostate cancer and evaluates data from several studies that attempt to correlate these microorganisms to the initiation and subsequent promotion of prostate cancer.