To effectively colonize a host animal and cause disease, many bacterial pathogens have evolved the mechanisms needed to invade and persist within host cells and tissues. Recently it was discovered that uropathogenic Escherichia coli, the primary causative agent of urinary tract infections, can invade and replicate within uroepithelial cells. This can provide E. coli with a survival advantage, allowing the microbes to better resist detection and clearance by both innate and adaptive immune defence mechanisms. Adhesive organelles, including type 1, P, and S pili along with Dr adhesins, promote both bacterial attachment to and invasion of host tissues within the urinary tract. Interactions mediated by these adhesins can also stimulate a number of host responses that can directly influence the outcome of a urinary tract infection.