# Research advances on the urinary microbiome in non-infectious urinary tract diseases: from community composition to clinical prospects

## TL;DR

Recent studies show that the urinary microbiome plays a key role in non-infectious urological diseases and could help in early diagnosis and personalized treatments.

## Contribution

This review highlights the urinary microbiome's role in non-infectious diseases and its potential for clinical applications like early diagnosis and precision medicine.

## Key findings

- Changes in the urinary microbiome are linked to chronic inflammation and disease progression in non-infectious urological conditions.
- Urinary microbial profiles can detect bladder and prostate cancers with over 80% accuracy using machine learning models.
- The urinary microbiome may affect immunotherapy outcomes, suggesting new approaches for personalized treatment.

## Abstract

With the rapid development of 16S rRNA sequencing and metagenomic technologies, the traditional concept of sterile urine has been completely overturned, and a diverse urinary microbiome has been identified even in healthy individuals. Increasing evidence indicates that dysbiosis of the urinary microbiome is closely associated with the onset and progression of various non-infectious urological diseases.

This review systematically summarizes recent advances in the role of the urinary microbiome in non-infectious urological diseases, including bladder cancer, benign prostatic hyperplasia, prostate cancer, nephrolithiasis, interstitial cystitis/bladder pain syndrome, and urinary incontinence, with a focus on microbial dysbiosis, pathogenic mechanisms, and clinical applications.

Studies have shown that alterations in the composition and diversity of the urinary microbiome are closely related to chronic inflammation, immune dysregulation, metabolic disturbances, and changes in the local microenvironment. These alterations may contribute to disease pathogenesis through mechanisms such as persistent low-grade inflammation, abnormal metabolic activity, and biofilm formation. In recent years, non-invasive detection based on urinary microbial profiles has shown promising potential in the early diagnosis of bladder and prostate cancers, with some machine learning models achieving diagnostic accuracies above 80 percent. Furthermore, the urinary microbiome may influence the efficacy of immunotherapy, offering new insights for personalized precision medicine.

This review summarizes the mechanisms, research status, and clinical prospects of the urinary microbiome in non-infectious urological diseases, emphasizing the importance of methodological standardization and highlighting its potential applications in early screening, diagnostic stratification, and microbiome-targeted interventions.