ReviewUrologie (Heidelberg, Germany)2026
[Non-muscle-invasive urothelial carcinoma of the bladder: time for a de-escalation of treatment and aftercare].
Review in Urologie (Heidelberg, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The aim of this review is to provide information on evidence-based therapy and aftercare strategies of low-risk bladder cancer. For low-grade non-muscle-invasive urothelial carcinoma of the bladder (LG-NMIB), active surveillance (AS) is recommended in international guidelines as a treatment alternative to repetitive transurethral bladder tumor resection (TURB). The background to these recommendations is the fact that (1) potentially less aggressive LG-NMIBs can be detected with a high degree of accuracy by experienced clinicians, (2) the rate of progression into invasive or high-grade bladder cancer is low, (3) about 30% of patients with putative LG-NMIB have no neoplasms, (4) complications after TURB are not uncommon, and (5) the costs of repetitive TURB are not insignificant. In addition to AS, a de-intensification of active therapy by chemoablation or fulguration under local anesthesia is also increasingly being discussed as a valid therapy option. Selection criteria for AS are a maximum of five visible pTaLG-pT1G1 tumors without a history of a high-grade tumor with a size < 10 mm, a negative cystology, and a corresponding compliance of the patient. When these factors are taken into account, the risk of progression to a muscle-invasive stage is less than 1%, 80-90% of patients remain without pT or G progression, and 50-60% of patients remain on AS for more than 3 years. AS includes cystoscopy at 6‑month intervals. In the event of a recurrence, AS can be continued in the case of LG tumors and missing risk factors, or active therapy by TURB, chemo- or laser ablation or fulguration is carried out. The latter therapy options can be performed on an outpatient basis under local anesthesia and have a recurrence-free survival of 50-60%. In summary, the options of AS and de-escalating interventional measures should be integrated more frequently into the therapy spectrum of non-muscle-invasive low-grade urothelial carcinoma of the urinary bladder.
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