Treatment with neoadjuvant chemotherapy (NAC) in muscle invasive bladder cancer (MIBC) is associated with clinical benefit in urothelial carcinoma. While extensive research evaluating role of tumor mutational expression profiles and clinicopathologic factors into chemoresponse has been published, the role of gut microbiome (GM) in bladder cancer in chemoresponse has not been thoroughly evaluated. A working knowledge of the microbiome and its effect on all forms of cancer therapy in BC is critical. Here we examine gut microbiome of bladder cancer patients undergoing NAC. Overall, there was no significant difference in alpha and beta diversity by responder status. However, analysis of fecal microbiome samples showed that a higher abundance of Bacteroides within both institutional cohorts during NAC was associated with residual disease at the time of radical cystectomy regardless of chemotherapy regimen. Group community analysis revealed presence of favorable microbial subtypes in complete responders. Finally, fecal microbial composition outperformed clinical variables in prediction of complete response (AUC 0.88 vs AUC 0.50), however, no single microbial species could be regarded as a fully consistent biomarker. Microbiome-based community signature as compared to single microbial species is more likely to be associated as the link between bacterial composition and NAC response.

Patients may turn to social media websites, such as Reddit, for information on erectile dysfunction prior to seeking care from a physician. We sought to identify, characterize, and assess the quality of the erectile dysfunction treatments discussed on the highly influential Reddit website. We assessed 2634 comments from two subreddits, r/AskMen and r/ErectileDysfunction, for positive and negative statements regarding treatments for erectile dysfunction. A total of 45 unique treatments were discussed and consisted of changes in sexual behavior (30%), lifestyle changes (29%), medical interventions (23%), talking with a partner about ED (10%), and use of supplements (8%). Only 24.4% of all treatments discussed are in line with current American Urological Association guidelines. Only 43.8% of all positive statements made endorsed a guidelines-based treatment, indicating a high rate of self-proclaimed success with alternative therapies. Our results indicate that there is active discussion of erectile dysfunction treatment on Reddit with a wide range of therapies recommended, however, the majority of the recommendations are not supported by strong clinical evidence.

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Introduction: The use of online health information by patients has gained considerable attention during the last decade. The National Institute of Health (NIH) and American Medical Association (AMA) advocate the dissemination of accessible and readable resources. We aimed to evaluate the readability of online patient resources from the Sexual Medicine Society of North America (SMSNA) website.Methods: Content published under the web-section “SMSNA: For Patients - conditions and topics'' portal (n=16) were reviewed. Identical topics published online via Urology Care Foundation (ie AUA; n=8) and the European Association of Urology (ie EAU; n=8) were also reviewed. Readability and estimated educational level required for understanding was assessed using validated readability and English language assessment tools including the Flesh Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau and Automated Readability index.Results: SMSNA online patient education materials (PEM), on average, are written at a college sophomore reading level (14th grade). This is 6.5 and 8 grade levels higher than the average U.S. adult and recommended reading levels for PEM, respectively. Comparable AUA and EAU resources were an average of 10th (p<0.05) and 12th (p=0.854) grade reading levels, respectively.Conclusion: Men’s sexual health PEM’s published online are written at an advanced reading level, most notably the SMSNA compared to equivalent professional sources. This could pose a barrier to patient understanding and impact patients’ engagement and health decision-making. One proposed mitigatory strategy is for PEM to provide improved readability, and appropriate user-friendly language to facilitate easier and inclusive understanding, outreach and educational support.