Search Results (184)

Background: Upper tract urothelial carcinoma (UTUC) is rare, and contemporary data on real-world healthcare resource utilisation and costs are limited. The objective of this study is to describe long-term healthcare resource utilisation among patients with upper tract urothelial carcinoma (UTUC) and to identify clinical and treatment-related drivers of costs. Methods: We conducted a retrospective, population-based cohort study including all patients diagnosed with UTUC between 2019 and 2023 in Region Skåne, Sweden. Patients were identified through the Swedish National Register for Urinary Bladder Cancer (SNRUBC) and linked to regional healthcare databases covering primary, secondary, and tertiary care. The primary outcome was annual direct healthcare cost per patient, derived from Diagnosis-Related Group (DRG) cost data and expressed in 2023 international dollars (Int$). Secondary outcomes were cost patterns and predictors stratified by treatment modality: robot-assisted nephroureterectomy (RANU), open nephroureterectomy (ONU), segmental ureterectomy (SU), and endourological treatment (ET). Results: Among 278 included patients, most were older adults and/or with substantial comorbidity, and over half underwent radical nephroureterectomy. The adjusted mean annual cost was Int$36,870 in 2019, decreasing to Int$30,004 in 2023. In the subgroup treated with ONU, systemic treatment was associated with a higher adjusted cost ratio and in the subgroup operated with SU, female sex was associated with a higher adjusted cost ratio. Comorbidity was a cost driver in the ET subgroup. Conclusions: UTUC care in this Swedish region has become less resource-intensive over a short period. These results can provide a basis for planning UTUC services and highlight targets for cost-conscious, patient-centred optimisation of care. Full article

Background/Objectives: Urothelial carcinomas are the most common tumors of the bladder. There are limited known cancer stem cell markers in these tumors. Ly6/uPAR gene family members are considered to be markers of cancer stem cells and tissue stem cells in mice, but studies on their expression or role in human cancers are limited. In this study, we aimed to investigate the expression of LY6/uPAR gene family members in human urothelial cancers. Methods: A total of 84 patients were included in the study. Patients diagnosed with urothelial carcinoma were divided into low-grade noninvasive and high-grade invasive carcinoma groups. Normal urothelial samples were used as a control group. RNA isolation was performed from paraffin blocks, and then cDNA was obtained. LY6D, LY6E, LY6H, LY6K, PSCA, LYPD2, SLURP1, GML, GPIHBP1, and LYNX1 genes were analyzed by qRT-PCR method. Results: We observed significantly higher expression of LY6E, LY6K, PSCA, GPIHBP1, and LYNX1 genes in urothelial carcinomas, but lower expression of LY6H, LYPD2, and SLURP1 genes in urothelial cancers compared to the control tissue. Decreased expression of LY6H, PSCA, LYPD2, SLURP1, and GPIHBP1 genes was significantly correlated with poor survival. Conclusions: In the present study, the expression of this gene family in bladder cancer was investigated for the first time in the literature. Given their potential prognostic role and possible relevance as therapeutic targets, this study presents preliminary observations that add to the existing literature. Full article

Background and Objectives: The systemic inflammatory response is important in cancer prognosis and progression. The inflammatory burden index (IBI) provides information about both inflammation and the immune response. Urothelial carcinomas are immunogenic; therefore, it has been suggested that inflammatory indices may predict disease prognosis. The aim of this study was to investigate the effects of systemic inflammatory indices, particularly the inflammatory burden index, on disease progression and overall survival in patients with metastatic urothelial cancer (affecting the bladder and upper urinary system) before first-line treatment and to demonstrate their prognostic importance. Materials and Methods: Within the scope of the study, the medical records of 130 patients who received systemic treatment for metastatic urothelial carcinoma at the medical oncology clinic were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal threshold values for IBI. Survival rates were calculated using the Kaplan–Meier method, and survival differences between groups were compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model to evaluate prognostic factors. Results: A total of 130 patients were included in the study. The median age was 64.9 years (IQR: 57.2–70.5). The primary tumor location was the bladder in 84.6% of patients, while the remaining 15.4% originated from the ureter and renal pelvis. In first-line systemic treatment, patients received a median of 4 cycles (IQR: 3–6). The median number of total treatment lines administered for metastatic disease was 1 (IQR: 1–2). In progression-free survival (PFS) analyses, the median PFS was 9.20 (95% CI 6.55–11.85) months in the IBI-low group (n = 47) and 5.82 (95% CI 4.56–7.07) months in the IBI-high group (n = 83) (p < 0.001). The median OS was calculated to be 18.96 (95% CI 16.61–21.30) months in the IBI-low group (n = 47), while it was found to be 9.50 (95% CI 7.70–11.29) months in the IBI-high group (n = 83) (p < 0.001). In multivariate analysis, high IBI and the presence of brain metastasis were found to be associated with the risk of progression. In terms of overall survival, the presence of brain metastasis, the presence of visceral metastasis, ECOG PS status, receipt of maintenance therapy, LMR, and the IBI score showed statistically significant prognostic effects. Conclusions: In metastatic urothelial carcinoma, the IBI was identified as an independent prognostic factor associated with progression-free and overall survival. These findings suggest that the IBI may have potential utility as a prognostic biomarker; however, larger, multicenter, and prospective studies are required to further validate its clinical applicability. Full article

Background and Clinical Significance: The coexistence of synchronous urologic malignancies may present diagnostic and therapeutic challenges, particularly when symptoms are minimal or nonspecific. This case illustrates the role of multimodal diagnostic correlation in identifying a second primary urologic malignancy during the evaluation of incidental PSA elevation. Case presentation: Case Presentation: We report the case of a 56-year-old male presenting with minimal lower urinary tract symptoms who underwent stepwise diagnostic evaluation including PSA (prostate specific antigen), free PSA, urinary SelectMDx RT-PCR testing (reverse transcription polymerase chain reaction), multiparametric MRI (magnetic resonance imaging), transrectal biopsy and inflammatory biomarker assessment. PSA was 17.69 ng/mL with a free PSA ratio of 6.56%. SelectMDx indicated a 90% probability of prostate cancer and a 65% risk of Gleason ≥ 7 disease. mpMRI demonstrated two suspicious lesions without extracapsular extension. Biopsy confirmed acinar adenocarcinoma Gleason 7 (3 + 4), Grade Group 2. Persistent post-biopsy hematuria led to additional imaging that revealed bladder wall thickening, and cystoscopy confirmed multifocal carcinoma in situ. Radical cystoprostatectomy with orthotopic ileal neobladder reconstruction was performed. Conclusions: This case illustrates the importance of diagnostic vigilance and multimodal correlation in a minimally symptomatic patient, particularly when persistent clinical findings are not fully explained by the initial diagnosis. The findings should be interpreted as illustrative and cannot be generalized beyond the single-case context. Full article

Upper tract urothelial carcinoma (UTUC) presents distinct diagnostic and therapeutic challenges because of its rarity, anatomic constraints, frequent understaging at biopsy, and risk of systemic recurrence after radical nephroureterectomy. Current perioperative management is driven primarily by clinicopathologic risk factors, which may be insufficient to identify occult molecular residual disease (MRD) or to determine which patients are most likely to benefit from systemic therapy. This narrative review summarizes available evidence on circulating tumor DNA (ctDNA) in UTUC and related urothelial carcinoma settings, classifies the level of evidence supporting each application, and proposes a research framework for prospective evaluation. The strongest UTUC-specific evidence supports ctDNA as a prognostic biomarker associated with recurrence risk, whereas predictive validity for selecting chemotherapy, immune checkpoint inhibitors, antibody-drug conjugates, targeted therapy, or surveillance intensity remains unproven. Evidence from muscle-invasive bladder cancer, including ctDNA-correlative and ctDNA-guided perioperative trials, provides biologic rationale but should not be directly translated into routine UTUC care without disease-specific validation. We outline key implementation questions, including target population, assay selection, timing, false-positive and false-negative results, lead-time bias, and integration of plasma ctDNA with utDNA. Prospective UTUC-specific trials are needed to determine whether ctDNA-guided perioperative strategies improve survival, reduce unnecessary toxicity, and are cost-effective. Full article

Schistosomiasis (bilharzia) is a parasitic infection caused by trematodes of the Schistosoma genus and remains a significant health burden in endemic regions. Granulomatous host responses to deposited Schistosoma eggs in small veins and tissues result in progressive changes and characteristic imaging findings. This diagnostic radiological review synthesizes the published literature and highlights key and robust imaging findings that facilitate the diagnosis of Schistosoma mansoni and Schistosoma haematobium, with emphasis on modality-specific patterns and disease staging. Schistosoma mansoni primarily affects the liver, causing periportal fibrosis visible as “pipe-stem” echogenic thickening upon ultrasonography, which may progress to portal hypertension and chronic liver disease. Liver cirrhosis is the end-stage disease manifested as an irregular liver contour with surface nodularity and lobar redistribution as right lobe atrophy with left and/or caudate lobe hypertrophy. Schistosoma haematobium predominantly affects the genitourinary system, causing urinary bladder wall thickening and calcification. Early disease, within three months of infection, may present with fine calcification, firstly in the bladder base and then extending to the whole bladder and even to the ureters. Calcification appears as a line or two parallel lines on radiography and as a circle in axial computed tomography (CT) images, which is pathognomonic for early-stage Schistosomiasis. In contrast studies, including conventional urography and CT urography, Schistosoma eggs appear as bubble-like filling defects in the ureter, kidney, and bladder, manifested as ureteritis, pyelitis, and cystitis cystica. Late stages appear as coarse calcification, fibrosis, strictures, and reduced bladder capacity and are associated with an increased risk of bladder squamous cell carcinoma. Moreover, Schistosomiasis calcification can present in genital organs, especially in the seminal vesicles; in the prostate in males; and in the vulva, cervix, and perineum in females. Ultimately, Schistosoma mansoni and haematobium eggs can reach the spinal cord, leading to acute myelopathy with paraparesis, urinary retention, or paraplegia. Recognition of characteristic imaging patterns of Schistosomiasis is essential for early diagnosis, accurate staging, and prevention of long-term complications. Full article

Upper-tract urothelial carcinoma (UTUC) represents a biologically distinct and clinically challenging subset of urothelial malignancies, accounting for only 5–10% of urothelial cancers but carrying a disproportionately high risk of advanced disease and recurrence. Historically, management strategies for UTUC have been extrapolated from bladder cancer data, with limited prospective evidence specific to the upper urinary tract. However, recent years have witnessed an expanding number of UTUC-focused clinical trials that are reshaping treatment paradigms across localized, locally advanced, and metastatic disease states. This review examines the evolving landscape of clinical trials in UTUC, highlighting pivotal and ongoing studies that will inform contemporary management. We summarize evidence supporting perioperative systemic therapy, including neoadjuvant and adjuvant chemotherapy, and discuss the expanding role of immune checkpoint inhibitors in both perioperative and metastatic settings. Additionally, we review trials evaluating kidney-sparing approaches, intraluminal therapies, and novel drug-delivery platforms aimed at preserving renal function while maintaining oncologic control. Emerging trial designs incorporating molecular profiling, fibroblast growth factor receptor (FGFR)-targeted therapies, and biomarker-driven patient selection are also explored. Despite meaningful progress, significant gaps remain, including the underrepresentation of UTUC patients in large urothelial cancer trials, heterogeneity in risk stratification, and challenges in trial accrual for this rare disease. We conclude by outlining future directions for UTUC-specific clinical research, emphasizing the need for collaborative, multicenter trials, innovative endpoints, and integrated translational studies to further refine personalized treatment strategies. As the clinical trial ecosystem for UTUC continues to mature, these efforts hold promises for improving outcomes while balancing oncologic efficacy with renal preservation. Full article

Background and Objectives: Bladder cancer is one of the most common malignancies of the urinary tract and poses a significant clinical challenge due to its biological heterogeneity and high rates of recurrence and progression. Urothelial carcinoma represents the predominant histological subtype, ranging from non-muscle-invasive disease with relatively favorable outcomes to aggressive muscle-invasive and metastatic forms associated with poor prognosis. Accurate diagnosis, staging, prognostic stratification, and assessment of treatment response are therefore essential for optimal patient management. The objective of this review is to summarize and critically evaluate the current evidence on the role of positron emission tomography/computed tomography (PET/CT) in bladder cancer, with particular emphasis on [¹⁸F]FDG PET/CT and non-FDG radiotracers. Materials and Methods: A narrative review of the available literature was performed, focusing on clinical studies, review articles, and guideline documents addressing the use of PET/CT in bladder cancer. The literature search included articles published between 2000 and 2025, while earlier landmark studies were selectively included if considered historically important for understanding the development of PET/CT imaging in bladder cancer. The initial search yielded over 500 records; after screening titles and abstracts, more than 100 articles were selected for full-text evaluation. The analyzed evidence encompasses the clinical applications of [¹⁸F]FDG PET/CT and alternative radiotracers, including choline-, acetate-, methionine-, and sodium fluoride-based tracers, and fibroblast activation protein inhibitors (FAPI), across different stages of disease and clinical settings. Results: Conventional imaging modalities, such as computed tomography and magnetic resonance imaging, provide important anatomical information but remain limited in the evaluation of lymph node involvement, early metastatic disease, treatment response, and disease recurrence. Despite limitations related to physiological urinary excretion, [¹⁸F]FDG PET/CT has demonstrated clinical value in selected scenarios, particularly for staging, prognostic assessment, detection of recurrence, and response evaluation. To overcome FDG-related constraints, several non-FDG radiotracers have been investigated. Among these, FAPI PET/CT has emerged as a promising modality due to its ability to target the tumor stroma, potentially improving lesion detectability and tumor-to-background contrast. Conclusions: This review summarizes and critically evaluates current evidence on the role of PET/CT in bladder cancer, with a focus on [¹⁸F]FDG PET/CT and non-FDG radiotracers. The discussed studies highlight their applications in primary diagnosis, staging, prognostic assessment, detection of recurrence, and evaluation of treatment response, as well as their respective advantages and limitations. Furthermore, potential future directions for PET/CT imaging in clinical practice are outlined, emphasizing the need for further research to clarify the optimal use of established and emerging radiotracers. Full article

Background and Clinical Significance: Urachal carcinoma (UrC) is an uncommon neoplasm derived from residual embryonic structures connecting the bladder to the umbilicus. Owing to its rarity, deep anatomic location, and histologic overlap with other glandular malignancies, accurate diagnosis remains challenging. Congenital anomalies of the lower urinary tract, including bladder exstrophy, are recognized as conditions that may predispose to malignant transformation of urachal remnants, although documented cases remain scarce. Case presentation: We describe the case of a 52-year-old male with bladder exstrophy and intellectual disability who presented with a progressively enlarging suprapubic mass and intermittent hematuria. Radiologic evaluation demonstrated a mass arising along the urachal tract. Surgical excision revealed a tumor composed of two morphologically distinct components: an enteric-type adenocarcinoma and a squamous carcinoma. Immunohistochemical profiling indicated urachal derivation and excluded other primary sites. Conclusions: This case expands the morphologic spectrum of UrC and emphasizes the diagnostic value of integrating clinical risk factors with detailed histologic and immunophenotypic assessment, particularly in tumors with mixed differentiation patterns. Full article

Background: Clear cell renal cell carcinoma (ccRCC) constitutes 75–80% of all renal cell carcinomas and exhibits aggressive behavior with high metastatic potential. Common metastatic sites include lungs, bones, lymph nodes, and liver, while urinary bladder involvement is exceedingly rare. Early detection of atypical metastases is critical for risk stratification, surgical planning, and systemic therapy selection. Methods: We report a 69-year-old male presenting with recurrent, painless gross hematuria and dysuria. Contrast-enhanced computed tomography revealed a left renal mass with bilateral pulmonary nodules, regional lymphadenopathy, and a bladder lesion. The patient underwent transurethral resection (TUR) of the bladder lesion, followed by robot-assisted left nephro-adrenalectomy with para-aortic lymphadenectomy. Histopathology and immunohistochemistry (PAX8+, CD10+, CAIX+, CK7−, GATA3−) confirmed ccRCC with synchronous bladder metastasis. Postoperatively, combined immune checkpoint inhibitor (ICI) therapy and tyrosine kinase inhibitors (TKIs) were initiated. Results: TUR provided symptomatic relief and diagnostic confirmation. Robot-assisted surgery enabled precise, oncologically safe excision of the primary tumor and regional metastases with minimal blood loss and no perioperative complications. Pathological staging was pT3aN1M1, ISUP grade 2, with lymphovascular invasion, confirming advanced disease requiring systemic therapy. Early initiation of ICI plus TKI therapy targeted residual micrometastases to potentially prolong survival. Conclusions: This case highlights the rare occurrence of ccRCC with synchronous bladder metastasis and underscores the importance of comprehensive imaging, detailed morphologic and immunohistochemical evaluation, and a multidisciplinary approach. Robot-assisted cytoreductive surgery combined with modern systemic therapy represents an effective strategy for advanced ccRCC, emphasizing the need for individualized treatment and long-term follow-up in atypical metastatic scenarios. Full article

Background: Urothelial carcinoma (UC) is characterized by high recurrence rates and the need for long-term surveillance. Cystoscopy remains the diagnostic gold standard but is invasive, costly, and burdensome for patients. Urine, as a tumor-proximal and non-invasive biospecimen, represents an attractive source for biomarkers enabling screening, diagnosis, risk stratification, and follow-up. Objective: This review summarizes current and emerging urine-based diagnostic approaches for UC, ranging from conventional cytology to advanced molecular technologies, and discusses their clinical utility, limitations, and future perspectives. Methods: A narrative review of the literature was conducted focusing on urine-based diagnostics for UC, including urinary cytology, FDA-approved and investigational protein and DNA/RNA biomarkers, next-generation sequencing (NGS), cell-free DNA (cfDNA), exosomes, and microRNAs. Evidence from clinical validation studies, meta-analyses, and translational research was evaluated. Results: Urinary cytology remains highly specific for high-grade disease but has limited sensitivity for low-grade tumors. Protein- and DNA-based biomarkers have improved sensitivity but often lack sufficient specificity for standalone use. Recent advances in NGS-based assays enable comprehensive detection of tumor-specific genomic alterations in urinary cfDNA, offering high sensitivity for both initial diagnosis and disease monitoring. Exosomes and microRNAs represent promising biomarkers reflecting tumor biology, though standardization and large-scale validation are ongoing challenges. Overall, multimodal approaches combining cytology with molecular assays appear most promising for clinical implementation. Conclusions: Urine-based diagnostics are rapidly evolving toward integrated liquid biopsy platforms capable of transforming UC management. While several assays show strong potential to reduce reliance on cystoscopy, robust prospective validation, cost-effectiveness analyses, and clinical integration strategies are required before widespread adoption. Full article

Background: This study describes treatment patterns and clinical outcomes in patients with advanced urothelial carcinoma (aUC) in the US following the approval of avelumab for first-line maintenance treatment. Methods: This retrospective cohort study used deidentified patient data from the Tempus database. Eligible patients had completed first-line systemic anticancer treatment for aUC between July 2020 and March 2023. Results: In total, 974 eligible patients were identified; most (72%) were male. Median age at diagnosis was 70 years. Among patients who completed first-line platinum-based chemotherapy (644 [66%]), 574 (89%) had no evidence of disease progression. Of 219 patients who received first-line maintenance, 135 (62%) received avelumab. Median (95% CI) overall survival (OS) and progression-free survival (PFS) from avelumab maintenance start were 14.9 months (13.1—not estimable [NE) and 6.4 months (4.6—NE), respectively. Enfortumab vedotin (EV) was the most common second-line treatment after avelumab (70%). Median (95% CI) OS and PFS from second-line EV start were 11.6 months (6.1—NE) and 6.6 months (4.1—NE), respectively. Conclusions: Results provide insights into the impact of avelumab first-line maintenance treatment in patients with aUC in the US. Effectiveness data are consistent with previous findings, supporting the use of avelumab maintenance in patients without disease progression following first-line platinum-based chemotherapy. Second-line EV after progression on avelumab maintenance had similar effectiveness to results from other real-world studies. Full article

Background/Objectives: Micropapillary urothelial carcinoma of the urinary bladder (MPUC) represents a rare but highly aggressive histological variant of urothelial carcinoma (UC), frequently presenting at an advanced stage of disease. Although data on histological variants consistently suggest inferior oncological outcomes, the independent prognostic role of the micropapillary variant remains controversial. Methods: The present work synthesizes the findings of a large meta-analysis evaluating histological variants of UC and a separate meta-analysis focusing exclusively on MPUC, and further examines the most recent cohort-based evidence published between 2016 and 2025. Results: The presence of any histological variant in UC treated with radical cystectomy is associated with significantly worse recurrence-free survival, disease-specific survival, and overall survival, as reflected by pooled hazard ratios (HRs). For the micropapillary variant specifically, a modest increase in overall mortality has been demonstrated (pooled HR ≈ 1.20); however, results from adjusted analyses dedicated to MPUC remain inconsistent. Conclusions: Micropapillary urothelial carcinoma is consistently associated with adverse pathological features and poorer oncological outcomes. However, whether micropapillary morphology independently predicts prognosis beyond established factors such as pathological stage and nodal status remains uncertain, as adjusted analyses across studies have yielded inconsistent results. Part of the observed survival disadvantage may be explained by stage migration, although an intrinsic residual risk cannot be definitively ruled out. This review integrates contemporary population-based registry analyses with prior meta-analytic evidence to provide a clinically oriented synthesis of the prognostic and therapeutic implications of MPUC. In addition, we propose minimal reporting standards aimed at improving comparability across future studies and strengthening risk stratification and treatment decision-making. Full article

Background/Objectives: Low-risk non-muscle-invasive bladder cancer (NMIBC) is associated with extremely low rates of progression and cancer-specific mortality. Current surveillance strategies recommend yearly cystoscopic surveillance after the initial 12-month period. Cystoscopic surveillance is costly, leading bladder cancer to be one of the most economically burdensome diseases. We investigated the use of a negative urinary dipstick for haematuria (UDH) in predicting the absence of recurrence. Methods: All patients undergoing flexible cystoscopy at our institution underwent urinary dipstick testing immediately prior to their procedures. We conducted a retrospective analysis of all patients undergoing cystoscopic surveillance for known low-risk NMIBC at our institution between January 2018 and August 2024. All patients had low-risk NMIBC, as defined by American Urological Association (AUA) guidelines, at the time of flexible cystoscopy. Patient demographics, cystoscopy operation records, and subsequent biopsy results were reviewed. Results: A total of 124 patients who underwent 310 cystoscopies were included in the analysis. The overall rate of UDH positivity was 54%. The negative predictive value (NPV) and sensitivity of UDH for the absence of bladder cancer recurrence were 95.7% and 81.2%, respectively. All cases of bladder cancer recurrence with negative UDH were low-grade Ta (n = 5) or papillary urothelial neoplasm of low malignant potential (PUNLMP) (n = 1). There was no difference in the NPV and sensitivity within 12 months of diagnosis (NPV = 95.4%, sensitivity = 83.3%) and 12 months after diagnosis (NPV = 95.8%, sensitivity = 80%). Conclusions: UDH has a high NPV and sensitivity for recurrence in low-risk NMIBC. No cases of high-grade tumors or carcinoma in situ were undetected by UDH in this study. UDH shows promise as an inexpensive adjunct test that can reduce the high economic burden of surveillance of non-muscle-invasive bladder cancer. Full article

Background: Urine cytology remains widely used for surveillance of non-muscle-invasive bladder cancer despite well-known limitations in sensitivity, especially for low-grade tumors. Uromonitor^®, a molecular assay detecting TERT promoter, FGFR3, and KRAS mutations in voided urine, has emerged as a promising adjunct. To evaluate its suitability for routine use, a consolidated assessment of diagnostic performance and a direct comparison with urine cytology are needed. Methods: We conducted a prospectively registered systematic review (PROSPERO CRD420251173244), synthesizing all available studies that evaluated Uromonitor^® for the detection of urothelial carcinoma of the bladder (UCB). Methodological quality was assessed using the QUADAS-2 framework, and certainty of evidence was evaluated following GRADE for diagnostic tests. Sensitivity was prespecified as the primary endpoint. Comparative datasets were identified, and random-effects meta-analyses were performed for sensitivity, specificity, accuracy, and predictive values (PVs). Results: Across eight cohorts evaluating Uromonitor^®, 832 of 3196 patients (26.0%) had histologically confirmed UCB. Aggregated sensitivity was 0.55 (95% CI 0.52–0.58). Specificity was 0.95 (0.94–0.96). Accuracy was 0.85 (0.83–0.86). PPV was 0.79 (0.76–0.82), and NPV was 0.86 (0.84–0.87). Across seven paired datasets, urine cytology demonstrated a sensitivity of 0.42, a specificity of 0.91, an accuracy of 0.78, a PPV of 0.64, and an NPV of 0.81. Pooled odds ratio for sensitivity was 3.16 (0.73–13.76), while diagnostic accuracy yielded 1.71 (1.01–2.90). Differences in specificity and NPV were not statistically significant, whereas the PPV favored Uromonitor^®, reaching statistical significance in pooled analyses. Conclusions: Uromonitor^® demonstrates higher sensitivity and improved accuracy compared with urine cytology, although current performance remains insufficient for stand-alone surveillance. The sensitivity estimate showed very low certainty due to pronounced heterogeneity, underscoring the need for careful interpretation. With advancing DNA recovery methods, incorporation of droplet digital PCR, and rigorous evaluations in prospective multicenter studies, Uromonitor^® may become an integral element of risk-adapted follow-up strategies. Full article