Exploring the enigma of not macroscopically detectable urothelial carcinoma: A scoping review on the definition, prevalence, diagnosis, and management of positive urinary cytology with absent macroscopic disease.

Introduction: There is a significant gap in the literature for cases of positive urinary cytology in the absence of macroscopically detectable disease for urothelial carcinoma. This condition, which we might define as not macroscopically detectable urothelial carcinoma (NMDUC), may be relatively rare but presents significant challenges in management and patient information. This review aims to search the literature for information useful for managing this condition. Material and methods: We structured the review as a scoping review given the desire to have a qualitative definition of NMDUC, without restrictions on study design or demographic characteristics. The review was structured around 5 domains: definition, diagnostic criteria, population, management, and time of disease progression. The review was conducted following the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines. Results: We found a total of 411 studies and selected 16 for inclusion in the review. Notably, no studies adequately addressed the definition of NMDUC directly. Our findings highlight the diagnostic challenges posed by NMDUC, especially the reliability of positive urinary cytology. The literature indicates a significant gap in the standardisation of diagnostic criteria and management for NMDUC. Conclusions: NMDUC represents a critical area of urological research requiring further investigation and clearer diagnostic guidelines. We propose the initiation of an international registry to better understand the prevalence, impact, and progression of NMDUC, aiming to standardise the definition and enhance management strategies. This work lays the groundwork for future research that could lead to significant improvements in the diagnosis and treatment of this challenging condition.