Diagnosis, evaluation, and management of patients with non-muscle invasive bladder cancer.

INTRODUCTION

Non-muscle invasive bladder cancer (NMIBC) accounts for over 75% of bladder cancer cases worldwide and is associated with high recurrence rates and significant surveillance costs. Advances in diagnostic modalities, risk stratification, and bladder-preserving therapies have transformed management strategies.

AREAS COVERED: This narrative review synthesizes evidence from 70 key publications identified through a comprehensive search of PubMed, MEDLINE, Embase, Scopus, and Google Scholar (2005-2025). Topics include clinical presentation, diagnostic innovations such as enhanced cystoscopy and urinary biomarkers, contemporary risk stratification models, and evolving treatment paradigms including intravesical therapy, immunotherapy, and gene therapy.

UNLABELLED: NMIBC management is shifting toward precision-based, multimodal approaches that integrate molecular biomarkers, immunotherapy, and novel drug delivery systems. While early-phase trials show promise, large-scale studies and real-world data are essential to validate these strategies. Personalized surveillance using circulating and urinary tumor DNA may reduce procedural burden and improve outcomes, marking a paradigm shift toward adaptive, patient-centered care.