Authored by Open Medicine, published on 2026-05-28 05:11:20.0
Risk-stratified management of NMIBC begins with TURBT, followed by surveillance for low-risk disease and intravesical therapy (BCG preferred) for intermediate- and high-risk tumors. Patients with BCG-unresponsive disease may receive bladder-preserving options such as nadofaragene firadenovec, pembrolizumab, or nogapendekin alfa inbakicept, with radical cystectomy remaining the definitive treatment.
NMIBC
TURBT
Low grade cTa < 3cm
Cystoscopic Surveillance
Int & High grade Recurrent LG, HG, T1, CIS
TURBT
Repeat TURBT within ~2–6 weeks after initial resection: • T1 disease (all patients) • High-grade Ta tumors • Any tumor with incomplete initial resection • No muscle in specimen (except clearly low-risk Ta LG)
Intravesical BCG (preferred) or Chemo
Radical cystectomy
Pembrolizumab
(BCG Refractory with CIS, refusing/ineligible for RC)