Urinary tract infections (UTIs) are a significant public health issue, affecting millions of people annually and causing substantial economic and societal costs. The most common pathogens causing UTIs are *Escherichia coli*, *Klebsiella pneumoniae*, *Proteus mirabilis*, *Enterococcus faecalis*, and *Staphylococcus saprophyticus*. UTIs can be categorized into uncomplicated and complicated types, with uncomplicated UTIs typically affecting healthy individuals and complicated UTIs associated with structural or functional urinary tract abnormalities. Adherence, colonization, and biofilm formation are key mechanisms by which uropathogens establish and persist in the urinary tract. Uropathogenic *E. coli* (UPEC) and other pathogens use various adhesins and pili to colonize the bladder and kidneys, evade immune responses, and cause tissue damage. Biofilms, formed through the production of extracellular polymeric substances and pili, protect bacteria from antibiotics and immune defenses. Morphological changes, such as filamentation, also aid in survival and persistence. Treatment options include antibiotics, but the rise of multidrug resistance poses a significant challenge. New therapeutic approaches, including combination therapies and vaccines targeting bacterial adhesins, are being developed to address this issue. Understanding the molecular mechanisms of pathogenesis and the evolution of resistance mechanisms is crucial for the development of effective treatments.Urinary tract infections (UTIs) are a significant public health issue, affecting millions of people annually and causing substantial economic and societal costs. The most common pathogens causing UTIs are *Escherichia coli*, *Klebsiella pneumoniae*, *Proteus mirabilis*, *Enterococcus faecalis*, and *Staphylococcus saprophyticus*. UTIs can be categorized into uncomplicated and complicated types, with uncomplicated UTIs typically affecting healthy individuals and complicated UTIs associated with structural or functional urinary tract abnormalities. Adherence, colonization, and biofilm formation are key mechanisms by which uropathogens establish and persist in the urinary tract. Uropathogenic *E. coli* (UPEC) and other pathogens use various adhesins and pili to colonize the bladder and kidneys, evade immune responses, and cause tissue damage. Biofilms, formed through the production of extracellular polymeric substances and pili, protect bacteria from antibiotics and immune defenses. Morphological changes, such as filamentation, also aid in survival and persistence. Treatment options include antibiotics, but the rise of multidrug resistance poses a significant challenge. New therapeutic approaches, including combination therapies and vaccines targeting bacterial adhesins, are being developed to address this issue. Understanding the molecular mechanisms of pathogenesis and the evolution of resistance mechanisms is crucial for the development of effective treatments.