J. Curtis Nickel, MD, FRCSC

J. Curtis Nickel, MD, FRCSC

Queen's University

Kingston, Ontario, Canada

Dr. Nickel is the Canada Research Chair in Urologic Pain and Inflammation and a Professor of Urology at Queen’s University in Kingston, Ontario. He is also a staff urologist at Kingston General Hospital. Dr. Nickel’s research covers inflammatory, benign prostate, and pain diseases of the urinary tract. He has over 550 publications, is on the editorial board of eight urology journals, serves as editor of the AUA Update Series, has presented in 45 countries, and is funded by the US NIH and Canadian CIHR. He has been awarded a CIHR Tier I Canada Research Chair (until 2021), as well as an AUA Distinguished Contribution Award and SIU Academy Award. He is currently Immediate Past-President of the Canadian Urological Association.

Disclosures:

Lectures by J. Curtis Nickel, MD, FRCSC

Beyond Antibiotics: Introducing Vaccine-Based Approaches to Recurrent UTIs in Women

J. Curtis Nickel, MD, FRCSC, the Canada Research Chair in Urologic Pain and Inflammation and Professor of Urology at Queen’s University in Kingston, Ontario, gives an overview of current and prospective treatment for recurrent urinary tract infections (UTIs), focusing on alternatives to antibiotics. He begins by summarizing the history of antibiotics for UTIs, noting that new antibiotics were discovered very quickly from the 1940s through the 1970s and that doctors believed at the time that infectious diseases would soon be a problem of the past. However, antibiotic-resistant microbes are now so prevalent that Dr. Nickel suggests that humanity is entering the “post-antibiotic era.” He then considers the available non-antibiotic treatments for recurrent UTI prevention in pre- and postmenopausal women. For premenopausal women, traditionally-recommended alternative prophylactic treatments include changes in hygiene practices, pre- and post-coital voiding, and avoidance of hot tubs, tampon use, and douching, but guidelines say that case-control studies demonstrate that these suggestions do not significantly impact recurrent UTI risk and can reinforce shame and self-blame. Dr. Nickel lists several alternative therapies with varying levels of evidence for this cohort, including increased water intake, cranberry extract, probiotics such as D-mannose, and methenamine hippurate. Dr. Nickel also recommends probiotics, D-mannose, and cranberry for postmenopausal women, though he also notes that the evidence-based approach for this cohort is vaginal estrogen therapy. According to Dr. Nickel, the future of recurrent UTI prevention for both cohorts is a vaccine. In the final part of his presentation, Dr. Nickel looks at treatment options for symptomatic UTI. Guidelines suggest antibiotics in these cases, but evidence indicates that UTI is typically self-limited and rarely progresses to more severe disease, and that there is little benefit to antibiotics for UTI beyond modestly faster symptomatic improvement. Dr. Nickel suggests treating symptomatic UTI with phenazopyridine, NSAIDS, urine alkalization, methenamine hippurate, and even herbal and dietary therapies. After summarizing his key points, Dr. Klotz goes into greater depth regarding vaccines for UTI prevention in a conversation with E. David Crawford, MD.

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An Introduction to the Urinary Microbiome: Part 3 – Manipulating the Microbiome for Urologic Health

In the third 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 possible ways to manipulate the microbiome to promote urologic health. He explains that, at present, there are four basic ways to positively influence the microbiome: eating a good diet, exercising, avoiding environmental pollution, and avoiding unnecessary antibiotics. Dr. Nickel also discusses various potential treatments currently being explored that involve manipulating the microbiome for managing disease, such as: gastrointestinal recolonization with Oxalobacter formigenes to treat urinary stone disease; targeting particular microbiota for cancer management; using Lactobacillus probiotics, fecal transplants, urine transplants, and a whole-cell inactivated bacteria vaccine to protect against urinary tract infections; and phage therapy. Dr. Nickel concludes that urologists do not have to always kill off bacteria, including seemingly pathogenic bacteria, but rather they need to understand how the bacteria changes in various disease states.

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An Introduction to the Urinary Microbiome: Part 2 – Impact on Urinary Disease

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.

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An Introduction to the Urinary Microbiome: Part 1 – A Primer

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.

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Infection and Prostate Cancer: “The Old Story”

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.

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