Management of High-Risk Non-Muscle-Invasive Bladder Cancer.

High-risk non-muscle-invasive bladder cancer represents a biologically heterogeneous disease with wide variation in recurrence and progression risk, creating persistent challenges in diagnosis, risk stratification, and management. Current guidelines rely on well-described clinicopathologic features to define risk; however, these factors alone often incompletely predict individual patient outcomes and efforts to refine prognostication using molecular profiling and advanced imaging techniques such as multiparametric MRI are under active investigation. Complete transurethral resection (TUR), including restaging TUR in appropriate patients, remains essential for both diagnosis and management.