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Review

The Role of the Urinary and Gut Microbiome in Bladder Cancer: Emerging Insights and Clinical Implications

by
Alexandra Lazcano-Ornelas
1,*,
Daniel Ajabshir
2,
Giulia Almiron
3,
Manish Choudhary
4 and
Neeraja Tillu
2
1
School of Medicine, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
2
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
3
School of Medicine, Metropolitan University of Santos, São Paulo 11045-002, SP, Brazil
4
Indiana Regional Medical Center, Indiana, PA 15701, USA
*
Author to whom correspondence should be addressed.
Submission received: 2 January 2026 / Revised: 21 February 2026 / Accepted: 1 April 2026 / Published: 13 April 2026

Abstract

Bladder cancer (BCa) arises from the interaction between environmental exposures and the host’s immunity and microbiome. Once considered sterile, the urinary tract is now known to harbor a resident urinary microbiome (UM) that dynamically interacts with the immune system and is influenced by systemic immunomodulatory effects of the gut microbiome (GM) brought on by the emerging gut–bladder axis. Accumulating evidence links alterations in UM and GM leading to BCa development, progression, and recurrence. Loss of protective taxa (e.g., Lactobacillus, Bifidobacterium and Ruminococcus) and enrichment of pro-inflammatory or genotoxic bacteria (e.g., Fusobacterium, Acinetobacter, Prevotella and Enterobacteriaceae) are associated with immune evasion and systemic inflammation. Microbial metabolites, especially short-chain fatty acids (SCFAs), play a key role in shaping tumor immunity and show diagnostic and prognostic potential, with specific microbial signatures correlating with recurrence risk, survival, and treatment response. Therapeutically, growing evidence suggests that microbiome composition influences immunotherapy response, highlighting opportunities for microbiome-based interventions. This review aims to summarize the rationale to implement microbial modulation strategies (e.g., dietary modulation, probiotics, fecal microbiota transplantation (FMT), and emerging synbiotic or postbiotic approaches) while addressing their current limitations and future requirements in order to develop microbiome-guided therapies, diagnostics and prognostic tools for BCa.
Keywords: bladder cancer; urinary microbiome; gut microbiome; immunotherapy; dysbiosis; intravesical therapy bladder cancer; urinary microbiome; gut microbiome; immunotherapy; dysbiosis; intravesical therapy

Share and Cite

MDPI and ACS Style

Lazcano-Ornelas, A.; Ajabshir, D.; Almiron, G.; Choudhary, M.; Tillu, N. The Role of the Urinary and Gut Microbiome in Bladder Cancer: Emerging Insights and Clinical Implications. Uro 2026, 6, 10. https://doi.org/10.3390/uro6020010

AMA Style

Lazcano-Ornelas A, Ajabshir D, Almiron G, Choudhary M, Tillu N. The Role of the Urinary and Gut Microbiome in Bladder Cancer: Emerging Insights and Clinical Implications. Uro. 2026; 6(2):10. https://doi.org/10.3390/uro6020010

Chicago/Turabian Style

Lazcano-Ornelas, Alexandra, Daniel Ajabshir, Giulia Almiron, Manish Choudhary, and Neeraja Tillu. 2026. "The Role of the Urinary and Gut Microbiome in Bladder Cancer: Emerging Insights and Clinical Implications" Uro 6, no. 2: 10. https://doi.org/10.3390/uro6020010

APA Style

Lazcano-Ornelas, A., Ajabshir, D., Almiron, G., Choudhary, M., & Tillu, N. (2026). The Role of the Urinary and Gut Microbiome in Bladder Cancer: Emerging Insights and Clinical Implications. Uro, 6(2), 10. https://doi.org/10.3390/uro6020010

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