1 Bacteria in the Genitourinary Tract: The Microbiota
and Probiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Gregor Reid
2 Overview of Urinary Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Joey Lo , Way Ho Choi , Justin Y. H. Chan , and Dirk Lange
3 Pathogenic Mechanisms of Uropathogens . . . . . . . . . . . . . . . . . . . . . . . 21
Ryan Chanyi , Jeremy P. Burton , and Peter A. Cadieux
4 Urosepsis-Pathogenesis and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Samir Bidnur and Ryan K. Flannigan
5 Struvite Stone Formation by Ureolytic Biofilm Infections . . . . . . . . . . 41
Logan N. Schultz , James Connolly , Ellen Lauchnor ,
Trace A. Hobbs , and Robin Gerlach
6 The Management of Infection Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Manoj Monga and Sarah Tarplin
7 The Use of Probiotic Bacteria to Treat Recurrent
Calcium Oxalate Kidney Stone Disease . . . . . . . . . . . . . . . . . . . . . . . . . 63
Brian R. Kullin, Sharon J. Reid, and Valerie R. Abratt
8 Role of Oxalobacter formigenes Colonization
in Calcium Oxalate Kidney Stone Disease . . . . . . . . . . . . . . . . . . . . . . . 77
John Knight and Ross P. Holmes
9 BCG for the Treatment of Non-muscle Invasive
Bladder Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Roland Seiler and Peter C. Black
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

The administration of antibiotic therapy is often used not just to treat proven infection,
but also to try and prevent recurrences, or in an attempt to reduce symptoms and signs
that are otherwise unexplained. These are being questioned primarily because of side
effects and antibiotic resistance [ 21 – 24 ], but they may also have consequences for
later obesity and its complications [ 25 ]. The development and use of broad spectrum
antibiotics was somewhat well intentioned, to rapidly provide relief from symptoms
of UTI without waiting for culture results. But, on refl ection it was poorly conceived.
A much better approach would have been to develop agents that specifi cally and only
targeted the offending organism, in the case of UTI mostly E. coli. With few, if any,
new antibiotics in the pipeline, and companies reluctant to invest in such research,
assuming such agents could even be developed, we are left with needing to carefully
assess when to use the current armamentarium and when not to. Options such as
relieving pain and using single dose therapy are worthy of consideration [ 26 , 27 ],
albeit with careful follow-up to ensure no precipitation of the infectious process.
The option of administering benefi cial bacteria to out-compete pathogenic ones
was fi rst considered in the early 1980s [ 28 ], but not taken seriously

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