Discovering the Urinary Microbiome

For more than a century, doctors thought urine was sterile. Now, microbiology breakthroughs are revolutionizing diagnosis and treatment of urinary tract infections.

Biology Medicine Microbiology

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May-June 2024

Volume 112, Number 3
Page 168

DOI: 10.1511/2024.112.3.168

For decades, medical students have typically been—and still are—taught that the bladder is sterile, but research over the past 15 years has confirmed what some of us have long suspected: The bladder has a microbiome, a resident community of microbes. This simple fact has profound implications for the most common infection treated in clinics around the world: the urinary tract infection (UTI). More than 400 million people globally are diagnosed with UTIs every year, making up 25 percent of all infections treated. UTIs are most common in people assigned female sex at birth, especially as they get older.

QUICK TAKE
  • One out of four infections treated are urinary tract infections (UTIs), but the standard diagnosis and treatment of UTI symptoms leave many people, especially older women, suffering.
  • The standard urine culture misses many uropathogens, yet continues to be used as a diagnostic, because alternatives are not widely available or well understood.
  • Research on the urinary microbiome since the 2010s is transforming care for chronic lower urinary tract symptoms. DNA sequencing and ecological understanding are key.

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