Urinary Biomarkers in Urothelial Carcinoma: Expanded Con-temporary Evidence for Diagnosis, Surveillance, Risk Stratification, and Cystoscopy-Sparing Clinical Pathways

Background/Objectives:Urothelial carcinoma remains one of the most surveillance-intensive malignancies in urologic oncology because, particularly in the non-muscle-invasive setting, it combines prolonged survivorship with frequent recurrence and the need for repeated cystoscopic reassessment. Conventional follow-up based on cystos-copy and urinary cytology is clinically entrenched but limited by invasiveness, patient discomfort, recurrent health-care utilization, and the well-recognized low sensitivity of cytology for low-grade disease. . Methods: The purpose of this paper is to review available literature regarding urinary biomarkers used in urothelial cancer from 2017 to 2026. . Results:The studied literature consistently shows that modern urinary bi-omarker platforms, particularly Xpert Bladder Cancer Monitor, Bladder EpiCheck, ADXBLADDER, and Cxbladder-derived assays, generally outperform conventional cy-tology in sensitivity while often preserving very high negative predictive value for clinically consequential recurrence, especially high-grade disease. In the Xpert litera-ture, overall sensitivity repeatedly exceeded that of cytology, while high-grade sensi-tivity and high-grade NPV were particularly favorable. Bladder EpiCheck similarly showed strong diagnostic and clinical utility, especially in the setting of atypical cytol-ogy and high-grade exclusion. ADXBLADDER and Cxbladder studies broadened the translational narrative by supporting less invasive, risk-adapted pathways, although neither primary haematuria data nor surveillance data yet justify universal replace-ment of cystoscopy. Results:Contemporary urinary biomarkers should not yet be in-terpreted as stand-alone substitutes for cystoscopy across all urothelial carcinoma set-tings. However, the cumulative evidence strongly supports their use as clinically meaningful adjuncts for high-grade recurrence exclusion, interpretation of equivocal findings, and selective cystoscopy de-intensification within personalized surveillance pathways.