Have You Read? February 2021

By: Daniel A. Shoskes, MD | Posted on: 01 Feb 2021

Akagawa Y, Kimata T, Akagawa S et al: Impact of long-term low dose antibiotic prophylaxis on gut microbiota in children. J Urol 2020; 204: 1320-1325.

The last decade has seen a deeper understanding of the gut microbiome as it influences physiology, pathophysiology, drug metabolism and even behavior. In urology we commonly give prolonged courses of low dose antibiotics to children for certain recurrent infections. Are we potentially impacting the gut flora of these children and possibly harming them in other ways?

In this study the authors conducted 16S ribosomal RNA gene sequencing using stool samples from 35 patients younger than 3 years old who underwent antibiotic treatment during the acute phase of febrile urinary tract infection. Samples were collected at 5 time points, ie before, during and at 1 to 2, 3 to 4 and 5 to 6 months after antibiotic treatment.. Continuous antibiotic prophylaxis using trimethoprim-sulfamethoxazole was initiated in 23 patients with grade III or higher vesicoureteral reflux and was not administered in 12 patients without reflux. Within 2 weeks almost all enteric bacteria belonged to the order Lactobacillales, and gut microbiota diversity decreased compared to the pretreatment level. The diversity recovered within 1 to 2 months after febrile urinary tract infection onset in both groups. Diversity was maintained during the study period in both groups (p=0.43).

The authors conclude that patients receiving continuous antibiotic prophylaxis had normal gut microbiota diversity. Furthermore, prophylaxis with trimethoprim-sulfamethoxazole might selectively suppress the growth of bacteria belonging to the order Enterobacteriales, such as Escherichia coli and Klebsiella species, which are the main causative bacteria of febrile urinary tract infections.

Lee A, Namiri N, Rios N et al: Dedicated residency research time and its relationship to urologic career academic success. Urology 2020; doi: 10.1016/j.urology.2020.10.037.

A dedicated research year during residency is a dwindling commodity. Given that most trainees go into private practice, do we have evidence that a single year dedicated to research during residency impacts future academic success? The authors included urologists graduating residency between 2002 and 2008 from 36 programs affiliated with a top 50 hospital for urology as ranked by the U.S. News and World Report, and collected research time during residency, fellowship training, current appointment (private practice, assistant professor, associate professor, professor, chair), National Institutes of Health (NIH) grant accrual, NIH R01 grant accrual and current H-index in Scopus database. Publication output during and after residency was identified through the PubMed database.

Of 543 urologists, 66.3% of graduating trainees pursued private practice. Increasing residency research time was associated with increased publication count (p <0.001), pursuit of professor positions (p <0.001) and NIH funding (p <0.001). A year of dedicated research increased the odds of being in the top tenth percentile of publication output during residency (OR 5.7, 95% CI 2.7–12.1), pursuing a fellowship (OR 2.0, 95% CI 1.3–3.1), promotion to professor (OR 4.9, 95% CI 2.0–12.2), obtaining a NIH grant (OR 6.2, 95% CI 2.3–16.5) and decreased the odds of pursuing private practice (OR 0.4, 95% CI 0.3–0.6). As amount of time dedicated to research in urological residency increased from 3–4 to 6–12 months, OR increased for career academic success metrics. The authors conclude that although a minority of trainees enter academics, dedicated time for research in urological residency is associated with career academic success, with more research time associated with increased publication output, academic appointments and grant funding.

Of course, residents with academic aspirations may self-select to apply to programs with more research time and resources, but it is still good to see that there is an association.

Ma SJ, Oladeru OT, Wang K et al: Prostate cancer screening patterns among sexual and gender minority individuals. Euro Urol 2020; doi: 10.1016/j.eururo.2020.11.009.

While there is a growing literature on specific needs and outcomes of gay men following prostate cancer, not much is known on prostate cancer screening behavior among lesbian/gay/bisexual/transgender (LGBT) individuals. The authors performed a cross-sectional study to assess patterns of prostate specific antigen (PSA) screening and decision-making in LGBT patients. The Behavioral Risk Factor Surveillance System database was queried for LGBT adults for 2014 to 2016 and 2018, when PSA questions were asked in the annual survey. Multivariable logistic regression was performed to evaluate the association of LGBT status with PSA screening and informed and shared decision making. A total of 164,370 participants were eligible for PSA screening, representing a weighted estimate of 1.2 million LGBT individuals. Compared to cisgender (CG) straight individuals, CG gay/bisexual cohorts were more likely to participate in PSA screening (CG gay OR 1.07, p <0.001; CG bisexual OR 1.06, p <0.001). CG gay participants were more likely to make informed decisions (OR 1.10, p <0.001) and engage in shared decision making (OR 2.55, p <0.001). Select gay populations were more likely to undergo PSA screening recommended by their clinicians and participate in informed and shared decision making.

The authors conclude that gay and bisexual individuals were more likely to undergo prostate cancer screening and that select gay individuals were more likely to make informed and shared decisions. However, transgender individuals were less likely to have prostate cancer screening and make informed decisions.

Certainly the risk of prostate cancer in transgender women treated with androgen deprivation is low1 but not 0, and clinical guidance for appropriate screening is needed.

  1. de Nie I, de Blok CJM, van der Sluis TM et al: Prostate cancer incidence under androgen deprivation: nationwide cohort study in trans women receiving hormone treatment. J Clin Endocrinol Metab 2020; 105: e3293.