From macroscopic clearance to molecular eradication: paradigm shift and future perspectives in the detecting of residual lesions after transurethral resection of bladder tumors.

INTRODUCTION

Residual lesions after transurethral resection of bladder tumor (TURBT) are a major contributor to recurrence in bladder cancer. Advances in diagnostic technology are shifting postoperative management from conventional macroscopic evaluation toward molecular-level assessment.

AREAS COVERED: A systematic search of PubMed, Web of Science and Embase from January 2000 to September 2025 identified studies on postoperative residual disease detection in non-muscle invasive bladder cancer (NMIBC). At the macroscopic level, enhanced cystoscopic modalities and artificial intelligence have improved visualization and recognition of subtle urothelial abnormalities. At the microscopic level, liquid biopsy approaches such as urinary tumor DNA, plasma circulating tumor DNA and exosome-based biomarkers enable more sensitive detection of minimal residual disease and dynamic molecular risk stratification beyond traditional cystoscopy and cytology. Integration of imaging findings with molecular profiling provides a more comprehensive basis for individualized surveillance and early therapeutic intervention in NMIBC.

EXPERT OPINION: Future priorities include standardizing diagnostic workflows, improving multi-omics integration and validating MRD-guided strategies in prospective studies. These developments may refine risk stratification, reduce recurrence, and support more personalized postoperative management in bladder cancer.