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For a deeper dive into the urinary microbiome, visit our next generation learning center: https://grandroundsinurology.com/next... 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.