The urine microbiome: what's normal and what's pathological? Microbiome-based treatment and prevention of urinary tract infections: A review

Research on the urine microbiome dates back approximately 150 years. Historically, the prevailing view was that the urinary system of a healthy individual is sterile. This paradigm, which seemed unshakable, defined approaches to diagnosing and treating urinary tract infections. Only in the last few decades has the scientific community's opinion on this issue changed radically. Progress in microbiological research has enabled the use of advanced culture and novel molecular genetic methods to identify microorganisms inhabiting the urinary tract. Finally, the well-established dogma of the urine sterility in a healthy person was shattered. Not only bacteria but also viruses and fungi are found in the urine. There is currently no consensus on which composition of the urine microbiota should be considered normal. However, the accumulated data indicate that changes in the urobiome's taxonomic composition can serve as predictors of various pathological processes. The underlying pathogenetic mechanisms remain to be further studied. A correlation has been identified between altered urinary microbiota and the development of both inflammatory and non-inflammatory diseases, in particular, benign prostatic hyperplasia, interstitial cystitis/painful bladder syndrome, urolithiasis, overactive bladder, urinary incontinence, and even bladder cancer. Of particular relevance in pediatric practice is the search for methods to prevent and treat urinary tract infections, thereby preserving and maintaining the diversity of microorganisms colonizing this system. One such method is the use of combined herbal medicinal products, such as Canephron N, which has diverse effects due to its active components. A distinctive feature of this herbal medicinal product, along with its multifaceted therapeutic effect, is its antimicrobial activity without inhibiting the commensal microbiota of the urinary tract. Canephron N is a valuable tool in the pediatrician's arsenal, helping maintain the fragile balance of the urobiome and prevent several pathological conditions.