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The urobiome

Following on from revelations that we have a complex symbiotic relationship with our #gut microbiome, the discovery that we also have a #urobiome has attracted much attention. There’s no going back to believing the urinary #bladder is sterile. Thank you, Alan #Wolfe.


Studies showing differences between normal and diseased bladder urobiomes raise questions about their influences on bladder health and disease aetiology, especially regarding #inflammatory and #pain syndromes, about which we know so little. The idea that we should protect a urobiome’s integrity in developing treatments for bladder pain syndromes and even bladder #cancers is worthy of investigation but not unreserved acceptance.


Correlation being interpreted as causative is a common flaw in deductive analysis and can misdirect clinical management as it did with urgency being attributed to uninhibited #detrusor contractions, encouraging oral #anticholinergic treatments to suppress detrusor at the cost of cognitive impairments and a raft of symptomatic side effects with little positive to offer beyond placebo.


As yet, I can find no information indicating we need to protect the urobiome, other than from known uropathogens, to protect human health or treat bladder diseases. The notion of bacterial imbalances reflects a Galenic view of health and disease. Furthermore, distinguishing intravesical commensals from symbionts appears yet to be established.


What I have found in 2024 is a probiotic industry capitalising on both our ignorance of bladder disease aetiologies and recurrent #uti  challenges by blatantly exploiting not only patients but also gullible specialist #uro-clinicians. It seems having a bladder disease is not only unhealthy but can be unjustifiably expensive for patients. At this time, such professional involvement appears to blur boundaries between placebo treatments and disreputable practices.

Prof. Scott Glickman

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