Impact of the urinary microbiome on urinary tract infection progression.

Introduction: Urinary tract infections (UTIs) remain a significant challenge in modern urology, increasingly complicated by the shift away from the "sterile bladder dogma." This narrative review summarizes current knowledge (2020-2026) on the urinary microbiome in women, men, and children, emphasizing the transition toward personalized urological care. Material and methods: We conducted a comprehensive synthesis of 48 peer-reviewed articles from PubMed, Scopus, and Google Scholar. This narrative review evaluates the interplay between the urinary microbiome, host immune response, and pathogen virulence, while critically comparing traditional urine cultures with advanced diagnostic tools, such as next-generation sequencing (NGS) and expanded quantitative urine cultures (EQUC). Results: Our analysis highlights the role of dysbiosis in UTI progression and the increasing threat of multidrug-resistant pathogens within the ESKAPEE group. Findings reveal that while modern diagnostics offer a more detailed microbial profile, clinical implementation remains constrained by technical and standardization challenges. Conclusions: Standard urine culture may be insufficient for managing recurrent or atypical UTIs. We advocate for a personalized diagnostic and therapeutic approach that integrates molecular insights, aiming to curb antibiotic overuse and improve patient outcomes in the era of rising drug resistance.