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The uncovering of microbes throughout the human body has changed the way health and disease is viewed. The fact that a urinary tract microbiome exists, irrespective of symptomatology, raises questions on what the microbes are doing. The microbial profile-associated bladder cancer compared to healthy controls suggests the organisms may contribute to urothelial abnormalities and carcinogenesis, especially given known carcinogenic properties associated with organisms like Escherichia coli. Antimicrobial and chemotherapeutic agents disrupt the microbiota, potentially increasing cancer risk, and influencing treatments such as BCG. The potential to manipulate the urinary microbiota using probiotic lactobacilli, E. coli, and other organisms is being reconsidered. Should certain species reduce the risk of cancer, the implications for patient care are significant. To assess this, the preclinical and pilot human studies need to be scaled up and mechanisms explored.