Urinary Tract Health: A Nutritional and Natural-Health Reference
1. Definition and Overview
Urinary tract health refers to how well the system works at removing wastes and producing and controlling urine, as well as any disorders or problems that might occur within the tract. The urinary tract is the body's drainage system for removing urine, which is made up of wastes and extra fluid. The mammalian urinary tract is a contiguous hollow-organ system whose primary function is to collect, transport, store, and expel urine periodically and in a highly coordinated fashion.
The urinary system filters waste products from the blood and produces urine. It also performs several additional physiological processes, such as regulating fluid volume and electrolyte levels, releasing hormones to control blood pressure and red blood cell production, and helping with bone health by controlling calcium and phosphorus levels.
The most clinically important urinary tract concern in a nutritional and natural-health context is the urinary tract infection (UTI). UTIs are the most common outpatient infections, with a lifetime incidence of 50–60% in adult women. UTI is a common microbial infection found in all ages and sexes which involves inflammation of the urinary tract. These infections can range from simple bladder inflammation (cystitis) to severe cases of uroseptic shock.
2. Anatomy and Physiology of the Urinary Tract
The urinary tract includes two kidneys, two ureters, a bladder, and a urethra.
- Kidneys: Two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to remove wastes and balance fluids, producing about 1 to 2 quarts of urine per day.
- Ureters: Thin tubes of muscle that connect the kidneys to the bladder and carry urine to the bladder.
- Bladder: A hollow, muscular, balloon-shaped organ that expands as it fills with urine. The bladder sits in the pelvis between the hip bones.
- Urethra: A tube located at the bottom of the bladder that allows urine to exit the body during urination.
The urinary tract includes two sets of muscles that work together as a sphincter, closing off the urethra to keep urine in the bladder between trips to the bathroom. The internal sphincter muscles of the bladder neck and urethra stay closed until the brain sends signals to urinate. The external sphincter muscles surround the internal sphincter and provide extra pressure to keep the urethra closed.
The process of constant urine flow in the upper urinary tract and intermittent elimination from the lower urinary tract plays a crucially important part in cleansing the urinary tract, ridding it of microbes that might have already gained access. The anatomical and physiological integrity of the urinary tract is of paramount importance in maintaining a healthy urinary tract.
2.1 Common Presentations of Urinary Tract Dysfunction
Symptoms of uncomplicated lower urinary tract infection include urinary frequency, urgency, dysuria, and suprapubic discomfort. Common symptoms also include a strong urge to urinate, cloudy or strong-smelling urine, and pelvic pain. If left untreated, UTIs can lead to more serious conditions such as kidney infections (pyelonephritis).
Cystitis is the inflammation of the bladder, commonly caused by a bacterial infection, and is a frequent type of UTI. Pyelonephritis is a type of UTI that specifically affects the kidneys, often resulting in more severe symptoms and complications.
Older women with UTIs are more likely to feel tired, shaky, and weak and have muscle aches and abdominal pain. In some older women, a UTI can quickly lead to a serious whole-body infection called sepsis.
3. Microbiology: Principal Causative Organisms
The most common causative agent for both uncomplicated and complicated UTIs is uropathogenic Escherichia coli (UPEC). UTIs are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus.
Bacteria are the most common cause of UTIs, although fungi can rarely also infect the urinary tract. E. coli bacteria, which live in the bowel, cause most UTIs.
Approximately 75% of uncomplicated UTIs are caused by extraintestinal pathogenic Escherichia coli, followed by Klebsiella pneumoniae and other pathogens. Complicated UTIs are associated with factors compromising the urinary tract or host defense, such as urinary obstruction, immunosuppression, renal failure/transplantation, and indwelling catheterization.
4. Contributing and Associated Factors
4.1 Anatomical and Sex-Related Factors
The female anatomy contributes to women's increased likelihood of contracting a UTI. A woman's urethra is shorter than a man's, allowing bacteria better access to the bladder. A woman's urethral opening is also close to sources of bacteria from the anus and vagina. The female urinary tract, with its relatively short urethra, is inherently predisposed to bacterial seeding and proximal spread. This anatomy increases the frequency of infections.
4.2 Age and Hormonal Status
The prevalence of UTI increases with age, and in women aged over 65 is approximately double the rate seen in the female population overall. Risk factors include an unfavorable family history, the female sex (anatomically, women have a shorter urethra), advanced age (increased incidence in older women is caused by altered health status including diabetes, neurogenic bladder, recent catheterizations, urinary tract obstructions, and chronic kidney disease), frequent sexual activity or with different partners, a suppressed immune system (in case of pre-existing HIV infection), use of the diaphragm or spermicides as a contraceptive method, and anatomical or hormonally induced changes in menopausal patients.
4.3 Sexual Activity and Contraception
In younger women, increased sexual activity is a major risk factor for UTIs and recurrence within 6 months is common. Some forms of birth control also increase the risk of UTIs. Spermicides can cause skin irritations that allow bacteria to invade. Diaphragms may slow urinary flow, encouraging bacteria to multiply.
4.4 Pregnancy
Pregnant women are more likely to get UTIs because of changes in the position of the uterus during pregnancy. In addition, pregnant women are more likely to have a UTI become a kidney infection. During late pregnancy, bladder capacity is reduced due to compression by the enlarging uterus, resulting in increased frequency of urination.
4.5 Comorbidities and Medical Factors
In multivariable analyses, characteristics associated with recurrent UTI included younger or older age, Charlson Comorbidity Index, and diabetes mellitus. Failure of standard first-line UTI therapy occurs in 10% to 18% of patients with uncomplicated UTIs, often due to factors such as bacterial resistance, patient non-compliance, renal failure, or undiagnosed urological issues. Risk factors for treatment failure include advanced age, chronic diarrhea, diabetes, foreign bodies in the urinary tract, male gender, and renal failure.
4.6 Bladder Habits
Holding in urine for too long can weaken bladder muscles and make it harder for the bladder to empty completely. Urine left in the bladder can allow bacteria to grow and makes a person more likely to develop a UTI.
5. Nutrients, Herbs, and Natural Ingredients
5.1 Cranberry (Vaccinium macrocarpon)
Traditional Use
Cranberries have long been used as a folk remedy to prevent UTIs. Cranberry products have been used widely for several decades to prevent urinary tract infections. The use of cranberry preparations for urinary complaints is documented in Native American traditional medicine and was carried into North American folk practice before the modern era of clinical investigation.
Proposed Mechanism
Cranberries contain proanthocyanidins (PACs), which inhibit the adherence of p-fimbriated Escherichia coli to the urothelial cells lining the bladder. This anti-adhesion mechanism is the most scientifically studied rationale for cranberry's potential role in urinary tract health.
Scientific Evidence
The evidence base for cranberry in UTI prevention is one of the most extensively reviewed in natural health. A 2023 Cochrane systematic review update added a further 26 studies, taking the total number of studies to 50 with 8,857 participants. These data support the use of cranberry products to reduce the risk of symptomatic, culture-verified UTIs in women with recurrent UTIs, in children, and in people susceptible to UTIs following interventions. The evidence currently available does not support its use in the elderly, patients with bladder emptying problems, or pregnant women.
A 2021 meta-analysis (23 trials, 3,979 participants) found that cranberry-based products intake can significantly reduce the incidence of UTIs in susceptible populations (risk ratio = 0.70; 95% CI: 0.59–0.83; P<0.01). A network meta-analysis published in 2024 (20 trials, 3,091 participants) found that 18 studies highlighted a 54% lower rate of UTIs with cranberry juice consumption than no treatment and a 27% lower rate than placebo liquid. Cranberry juice also resulted in a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment.
A 2012 meta-analysis (13 trials, 1,616 subjects) concluded that cranberry-containing products are associated with a protective effect against UTIs, but this result should be interpreted in the context of substantial heterogeneity across trials.
Evidence strength: Moderate. The 2023 Cochrane review is the most authoritative synthesis and shows benefit in defined subgroups, particularly women with recurrent UTIs. However, heterogeneity across trials, variation in PAC dose and formulation, and lack of standardization in cranberry products remain limitations. Evidence does not support use in all populations.
5.2 D-Mannose
Proposed Mechanism
D-mannose is an inert monosaccharide that is metabolized and excreted in urine and acts by inhibiting bacterial adhesion to the urothelium, representing a promising non-antibiotic prevention strategy. When excreted in urine, D-mannose potentially inhibits Escherichia coli, the main causative organism of UTIs, from attaching to urothelium and causing infection.
Scientific Evidence
A landmark randomized clinical trial (KranjÄŤec et al., published in the World Journal of Urology, 2013) enrolled 308 women with recurrent UTIs. After initial antibiotic treatment of acute cystitis, women were randomly allocated to three groups: 2 g of D-mannose powder daily for 6 months, 50 mg nitrofurantoin daily, or no prophylaxis. Overall 98 patients (31.8%) had recurrent UTI: 15 (14.6%) in the D-mannose group, 21 (20.4%) in the nitrofurantoin group, and 62 (60.8%) in the no prophylaxis group, with the rate significantly higher in the no prophylaxis group. In that study, D-mannose powder had significantly reduced the risk of recurrent UTI, which was not significantly different from the nitrofurantoin group.
A 2024 randomized clinical trial published in JAMA Internal Medicine sought to determine whether D-mannose taken for 6 months reduces the proportion of women with recurrent UTIs experiencing a medically attended UTI. D-mannose is a monosaccharide isomer of glucose that may inhibit bacterial adherence to uroepithelial cells by binding to a site on the tip of the fimbria, and has shown benefit in animal models in preventing UTIs. Although a recent Cochrane systematic review concluded that there was insufficient evidence to support D-mannose for UTI prophylaxis, an open randomized trial that compared D-mannose, antibiotic prophylaxis, and usual care found evidence of benefit.
D-mannose alone or in combination with several dietary supplements or Lactobacillus has a potential role in the non-antimicrobial prophylaxis of recurrent UTI in women. There is low-level evidence, from a small number of studies, supporting the use of D-mannose or combination treatments for potentially preventing UTIs in adult women without producing burdening side effects.
D-mannose is well tolerated, with few reported adverse events (diarrhea was reported in about 8% of patients receiving 2 g of D-mannose for at least 6 months).
Evidence strength: Preliminary to moderate. The available human evidence is encouraging, particularly for recurrent UTI prevention, but the overall body of trials is small. The Cochrane review has found the evidence insufficient for a definitive recommendation. Further well-powered RCTs are needed.
5.3 Uva Ursi / Bearberry (Arctostaphylos uva-ursi)
Traditional Use
Uva ursi is an herbal extract derived from the leaves of the Arctostaphylos, a small evergreen shrub, which has been used in Native American traditional medicine for treatment of urinary tract symptoms and as a diuretic. Arctostaphylos uva-ursi and its leaf preparations are generally considered to have antibacterial activity and are traditionally used for treatment of the lower urinary tract infections. Uva ursi has been used to treat dysuria, cystitis, urethritis, and kidney and bladder stones.
Active Constituents and Proposed Mechanism
Uva ursi leaves contain several phytochemicals, including ursolic acid, tannic acid, gallic acid, oils, resins, hydroquinone glycosides (mainly arbutin), and flavonoids. The active component of uva ursi is suspected to be hydroquinone, and particularly arbutin and methyl arbutin, which may have anti-inflammatory and antiseptic activities that are excreted in the urine. Approved by the German Commission E for inflammatory disorders of the urinary tract, uva ursi leaves contain a potent urinary antiseptic called arbutin. Arbutin is hydrolyzed in alkaline urine to hydroquinone.
Scientific Evidence and Regulatory Status
The EMA's Committee on Herbal Medicinal Products (HMPC) concluded that, on the basis of its long-standing use, bearberry leaf preparations can be used for treating symptoms of mild, recurrent infections in the lower urinary tract. The HMPC conclusions on the use of these bearberry leaf medicines for lower urinary tract infections are based on their "traditional use." This means that, although there is insufficient evidence from clinical trials, the effectiveness of these herbal medicines is plausible and there is evidence that they have been used safely in this way for at least 30 years (including at least 15 years within the EU). In its assessment, the HMPC considered laboratory studies which showed bearberry leaf preparations to have antibacterial action.
While uva ursi has been used extensively in traditional medicine, there is no convincing medical evidence that it is effective in treating urinary tract infections or urinary symptoms. Owing to its high tannin content, uva ursi should not be taken for more than 1 week.
Evidence strength: Weak for human clinical benefit. Regulatory approval in Germany and a traditional-use listing by the EMA acknowledge historical use and in vitro antibacterial evidence, but controlled human clinical trials confirming efficacy are lacking.
5.4 Probiotics (Lactobacillus species)
Traditional and Rationale-Based Use
Because Escherichia coli is the primary pathogen involved in UTIs and spreads from the rectum to vagina before ascending the urinary tract, improving the gut or vaginal flora impacts the urinary tract. Since a healthy vaginal microbiota is mainly dominated by Lactobacillus species, exogenously administered probiotics containing lactobacilli play a pivotal role in reducing the risk of recurrent UTI.
Scientific Evidence
A systematic review and meta-analysis was performed to compile results from randomized clinical trials to determine the efficacy of probiotic Lactobacillus species in preventing recurrent UTI. MEDLINE and EMBASE were searched from inception to July 2012 for RCTs using a Lactobacillus prophylactic against recurrent UTI in premenopausal adult women. Data from 294 patients across five studies were included. There was no statistically significant difference in the risk for recurrent UTI in patients receiving Lactobacillus versus controls in the overall analysis. A sensitivity analysis restricted to effective strains found a statistically significant decrease in recurrent UTI in patients given Lactobacillus (pooled risk ratio 0.51, 95% CI 0.26–0.99, p=0.05). Probiotic strains of Lactobacillus are safe and effective in preventing recurrent UTI in adult women; however, more RCTs are required before a definitive recommendation can be made since the patient population contributing data was small.
Probiotics appear to have a significant potential in prevention of recurrent UTI; however, additional data are needed to understand how they can be effectively used in clinical practice. Since the effects of probiotics are strain-specific, the efficacy and safety of each strain has to be assessed.
Evidence was found that Lactobacillus species (particularly L. rhamnosus GR-1 and L. reuteri RC-14) may be beneficial. Probiotics do not cause antibiotic resistance and may offer other health benefits due to vaginal re-colonisation with lactobacilli.
Evidence strength: Preliminary to moderate, and highly strain-dependent. Results are inconsistent across trials. Overall evidence is not sufficient for a universal recommendation, but certain strains show promise.
5.5 Diuretic Herbs: Goldenrod, Horsetail, Parsley, and Stinging Nettle
Traditional Use
A review covering medicinal plants native to North America and Europe traditionally used for urinary tract infections includes goldenrod (Solidago canadensis, S. virgaurea, and S. gigantea), horsetail (Equisetum arvense), dandelion (Taraxacum officinale), and corn silk (Stigma maydis) among the traditional plants used. These herbs have been used across European folk medicine traditions as aquaretics and urinary tonics, prepared most commonly as teas or decoctions.
Proposed Mechanism and Scientific Evidence
Diuretic botanicals like goldenrod (Solidago virgaurea), birch (Betula spp.), couch grass (Elymus repens), and horsetail (Equisetum arvense) work against UTI by increasing urinary volume and supposedly flushing bacteria out of the urinary tract. Several diuretic and anti-inflammatory herbs, including goldenrod, parsley (a source of apigenin), and stinging nettle, have been reported to increase urine output and reduce pro-inflammatory cytokine release. Notably, extracts from Solidago virgaurea have demonstrated the ability to reduce E. coli biofilm formation. However, they also antagonized the post-antibiotic effects of amikacin and ciprofloxacin, highlighting the importance of combination testing before clinical application.
Further herbal drugs that could help to prevent recurrent urinary tract infection because of their diuretic properties include goldenrod, lovage, birch, parsley, and celery. Although these reports are on the first sight promising, there is still discrepancy in the results of the underlying clinical studies, making it difficult to judge inasmuch herbal medicinal products can be a good alternative or supplement to standard therapies.
Evidence strength: Preliminary. Most evidence for diuretic herbs in urinary tract support is from in vitro studies, small clinical studies, or expert-consensus European Pharmacopoeia monographs. Large RCTs are lacking.
5.6 Garlic (Allium sativum)
Traditional Use
Garlic has been used across diverse traditional medical systems—including Traditional Chinese Medicine, Ayurveda, and European herbal medicine—as an antimicrobial and anti-infective agent for urinary and systemic infections.
Proposed Mechanism and Scientific Evidence
Garlic (Allium sativum) is widely identified for its strong anti-inflammatory and antimicrobial activity, making it a valuable potential treatment for various infections, including UTIs. The primary bioactive compound responsible for these therapeutic effects is allicin, which is naturally produced upon crushing or chopping garlic. Allicin plays a pivotal role in inhibiting UTI-causing bacteria, such as S. aureus and E. coli, by disrupting essential bacterial enzymes and metabolic pathways. Roots rich in organosulfur and polyphenolic compounds, such as garlic (which contains allicin), ginger (a source of gingerols), and turmeric (which provides curcumin), exert antimicrobial effects by targeting thiol-containing enzymes, DNA gyrase, and oxidative stress pathways.
In test-tube studies, allicin exhibits strong antibacterial effects against a variety of infectious, UTI-causing bacteria, including E. coli. Additional evidence from individual case reports suggests that garlic may be an alternative therapy for treating UTIs in humans, but strong research to validate these results is lacking. Ultimately, more well-designed studies are needed to better understand the role garlic may play in treating and preventing recurrent UTIs before any definitive conclusions can be drawn regarding its effectiveness or ideal dosage.
Evidence strength: Preliminary, mainly in vitro. Clinical evidence in humans is absent or anecdotal.
5.7 Other Traditionally Used Plants
Ayurvedic herbs like Tribulus terrestris, Boerhavia diffusa, Tinospora cordifolia, and Santalum album are used since time immemorial for UTI in India. People who consume antiseptic and anti-adhesive herbs like Arctostaphylos uva-ursi, Juniperus spp., and cranberry excrete antimicrobial compounds which may directly kill microbes or interfere with their adhesion to epithelial cells, thereby protecting against acute and chronic UTI.
Diuretics like goldenrod herb, lovage root, parsley fruit, and stinging nettle increase urine volume in both healthy people and people with urinary disorders, which helps in flushing out probable threats. These plants appear in European Pharmacopoeia listings and national herbal monographs, but robust clinical trial evidence specific to urinary tract infection outcomes is limited for most of them.
5.8 Vitamin C (Ascorbic Acid)
Proposed Mechanism
Vitamin C has been proposed to support urinary tract health primarily through urine acidification. Bacteria that cause UTIs, like E. coli, often thrive in a neutral or slightly alkaline environment. By lowering the pH (increasing the acidity) of urine, vitamin C might inhibit the growth of these bacteria, making it harder for them to multiply and cause an infection. However, the effectiveness of vitamin C in acidifying the urine can vary greatly among individuals, depending on their metabolism and baseline urine pH.
Scientific Evidence
The majority of studies investigating vitamin C's effects on urinary health are limited in scope, often focusing on small populations or specific patient groups (like pregnant women). Some studies suggest that vitamin C supplementation may reduce the incidence of UTIs, while others show no significant benefit. Current studies investigating the efficacy of vitamin C for UTI prevention exhibit mixed results. Notably, many of these studies have primarily been laboratory-based, exploring in vitro scenarios rather than clinical trials in actual patients.
The belief that vitamin C acidifies urine enough to prevent UTIs is largely a myth, as the effect is often too slight or brief to create a hostile environment for most bacteria.
Vitamin C has also been discussed as a urinary acidifier in the management of recurrent UTIs in clinical practice guidelines. Managing recurrent UTIs generally involves optimizing personal hygiene, using vitamin C as a urinary acidifier, taking additional precautions after sexual contact, and considering prophylactic antibiotics. However, this use reflects clinical practice convention rather than robust randomized trial data specifically for vitamin C.
Evidence strength: Weak and mixed. Human clinical trial evidence is sparse; in vitro plausibility exists but physiological acidification through dietary or supplemental vitamin C is uncertain and inconsistent.
6. Dietary and Lifestyle Factors
6.1 Hydration
Adequate fluid intake is one of the best-supported lifestyle factors for urinary tract health. The process of constant urine flow in the upper urinary tract and intermittent elimination from the lower urinary tract plays a crucially important part in cleansing the urinary tract, ridding it of microbes that might have already gained access.
A landmark randomized controlled trial by Hooton et al., published in JAMA Internal Medicine (2018), provided the first high-quality RCT evidence specifically for water intake and recurrent UTI. The study enrolled 140 premenopausal women who experienced 3 or more UTIs per year and drank less than 1.5 liters of fluid daily. The water group added 1.5 liters per day to their usual intake. Over 12 months, they averaged just 1.7 UTI episodes compared to 3.2 in the control group, and used nearly half as many antibiotics (1.9 courses vs 3.6). Women who increased their daily water intake by 1.5 liters had 48% fewer UTI episodes over 12 months.
NIDDK guidance recommends drinking enough liquids, especially water. For healthy individuals, six to eight 8-ounce glasses of liquid per day are suggested. Those with kidney stones or bladder stones may need to drink more, and at least half of liquid intake should be water.
Evidence strength: Moderate to strong for women with recurrent UTIs and low baseline fluid intake, supported by the Hooton 2018 RCT.
6.2 Dietary Pattern and Food Choices
Recent studies suggest that dietary choices can influence the susceptibility to UTIs. A nutrient-rich diet not only supports a healthy immune system but also helps in maintaining an optimal urinary pH, discouraging bacterial growth.
Research published in PMC (2024) examining behavioral risk factors found that to evaluate the influence of dietary habits on the frequency of urinary infections, multinomial logistic regression was performed, involving the outcome variable "adherence to a healthy diet" and examining the influence of independent variables such as gender, age, area of residence, education level, BMI, and frequency of urinary tract infections.
Fermented and probiotic foods are discussed in this context: probiotics are beneficial bacteria that can support urinary health by balancing the vaginal and gut microbiome, which in turn reduces the colonization of harmful bacteria like E. coli. Foods such as yogurt, kefir, sauerkraut, and kimchi are rich in probiotics.
6.3 Bladder-Voiding Habits
Taking enough time to fully empty the bladder when urinating is recommended. Urinating after sex helps flush away bacteria that may have entered the urethra during sexual activity. Cleaning the genital area before and after sex is also advised. For women, wiping from front to back, especially after a bowel movement, helps keep bacteria from getting into the urethra.
6.4 Avoidance of Irritants
Authoritative sources describe dietary bladder irritants as potential contributors to urinary tract symptoms. Caffeine, carbonated beverages, and alcohol have been discussed as factors that may irritate the bladder lining or alter urinary patterns, though robust RCT evidence on these dietary factors in relation to UTI incidence specifically is limited in the peer-reviewed literature.
6.5 Diabetes and Glycemic Control
Identifying predisposing factors for infection and correcting them, if possible, is helpful. For example, a diabetic patient would benefit from improving glycemic control. Elevated urinary glucose concentrations in poorly controlled diabetes create an enriched culture medium for uropathogenic bacteria, and diabetes mellitus is independently associated with increased risk of recurrent UTI.
7. Summary of Evidence Strength by Intervention
- Increased water intake: Moderate–strong. Supported by an RCT (Hooton et al., 2018) specifically in women with recurrent UTIs and low baseline fluid intake.
- Cranberry products (PAC-standardized): Moderate. The 2023 Cochrane review (50 RCTs, 8,857 participants) supports use in women with recurrent UTIs and in children; heterogeneity and formulation variation limit broader conclusions.
- D-Mannose: Preliminary to moderate. Positive signal from one RCT (KranjÄŤec et al., 2013) and a 2024 JAMA Internal Medicine RCT; Cochrane review considers evidence insufficient for a firm recommendation.
- Lactobacillus probiotics (strain-specific): Preliminary. Meta-analysis shows potential benefit with specific strains (L. rhamnosus GR-1, L. reuteri RC-14), but evidence body is small and strain-dependent.
- Uva ursi (bearberry leaf): Traditional use; EMA traditional-use listing; in vitro antibacterial evidence; no conclusive human RCTs confirming clinical efficacy.
- Diuretic herbs (goldenrod, horsetail, parsley, nettle): Preliminary; in vitro and small clinical data; EMA or Commission E monograph support in some cases; robust RCTs absent.
- Garlic (allicin): Preliminary, mainly in vitro. No human clinical trial evidence for UTI prevention or treatment.
- Vitamin C: Weak and mixed. Biological plausibility limited; acidification effect uncertain; no robust human RCTs for UTI specifically.
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