Current Evidence on the Use of Cystoscopy in the Follow-up of Non-Muscle-Invasive Bladder Cancer: Are We Overusing It? Systematic Review of the Literature.

BACKGROUND

Non-muscle-invasive bladder cancer (NMIBC) accounts for the majority of bladder cancers. Its follow-up entails high costs and significant impact on quality of life. Cystoscopy is the standard method, although uncertainties remain regarding the optimal frequency and duration. The aim was to review the available evidence on surveillance schedules and their impact on recurrence and progression.

METHODS

A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses). Searches in PubMed, Web of Science and Scopus included clinical and observational studies published between 2004 and 2024. After applying inclusion criteria and assessment with QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies), 8 articles were selected out of a total of 3679.

RESULTS

The studies included a total of 30,600 patients. With regard to the first cystoscopy, performing it within 3-4 months after transurethral resection of the bladder showed better outcomes, whereas excessively early or delayed procedures increased the risk of recurrence and progression. In low-risk patients, some studies support discontinuing surveillance after 5 years without recurrence, while others recommend prolonging it in patients with risk factors such as smoking or multiple tumours. In high-risk patients, across the different surveillance schedules analysed, no differences were found in terms of mortality or progression. No conclusive studies were identified for the intermediate-risk group.

CONCLUSIONS

The first cystoscopy should be performed within 3-4 months after the initial surgery. Although risk-stratified recommendations exist, current evidence is limited and sometimes contradictory. Prospective and long-term studies are required to define optimal surveillance schedules, with the aim of optimising resources and reducing the burden on patients.