The Urinary Microbiome: Shifting Paradigms from Sterile Urine to Microbial Dysbiosis in Chronic Pelvic Pain Syndrome

Abstract

The prevailing dogma regarding urinary tract sterility has been fundamentally challenged by advances in culture-independent molecular techniques. The urinary microbiome, also known as the urobiome, is defined as a complex ecosystem comprising bacteria, fungi, and viruses. This microbiome plays a pivotal role in maintaining urological health. Emerging evidence suggests a potential link between urinary microbial dysbiosis and the pathogenesis of Urologic Chronic Pelvic Pain Syndrome (UCPPS), a clinical umbrella term that explicitly encompasses two major phenotypes: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). This review examines the paradigm shift in understanding urinary tract microbiology, characterizes the urobiome in health and disease, and explores the therapeutic implications of microbiome-targeted interventions for UCPPS management.