Bacillus Calmette-Guérin (BCG) remains the cornerstone in the treatment of high-risk non-muscle-invasive bladder cancer (NMIBC), effectively preventing recurrence and progression. Unfortunately, a significant proportion of patients are classified as BCG-unresponsive, and there have been no definite alternative treatments for these disease group except for radical cystectomy, which is still challenging and sometimes not applicable. Therefore, there has been a need for alternative bladder-preserving treatments for patients who desire a bladder-sparing approach or are too frail for major surgery. Intravesical therapies, such as gemcitabine, mitomycin C and docetaxel, are mostly studied approaches, showing some promising results. However, no definitive conclusion has be drawn because of the heterogeneity of the studies and protocols and the limited number of patients enrolled in most of these studies. Immunotherapy and anti-inflammatory agents, though promising, require further validation through ongoing clinical trials to ensure their safety and efficacy. Gene therapy is also being explored, though it is in its early stages, with challenges in gene delivery and immune regulation still to be addressed. Photodynamic therapy and hyperthermia, particularly in combination with other treatments like intravesical chemotherapy, have shown potential in improving outcomes for BCG-unresponsive patients, though they are not yet considered first-line treatments. While these novel approaches hold promise, more robust data and clinical trial results are necessary to guide treatment protocols. In conclusion, ongoing research and clinical trials will continue to shape the future of NMIBC management, with the aim of providing more effective and bladder-preserving options for patients.

Park JH, et al. Investig Clin Urol. 2025 Jul;66:e49. https://doi.org/10.4111/icu.20250165

Benefit of pentosan polysulfate sodium (PPS) for reducing chronic pain and lower urinary tract symptomin patients with interstitial cystitis/bladder pain syndrome (IC/BPS) remains inconclusive with modest effect. We aimed to evaluate the impact of PPS on improvement of lower urinary tract symptom based on the International Prostate Symptom Score (IPSS), quality of life (QoL), and uroflowmetry (UFM) in patients with IC/BPS. A total of 204 patients who were prescribed oral PPS for IC/BPS from October 2006 to May 2021 were retrospectively reviewed. Patients were divided by age for treatment effect comparison. Linear mixed models were utilized to evaluate improvements in IPSS, QoL, and UFM parameters after PPS treatment. There were significant gains in total IPSS (−0.335, P < 0.001) and QoL (−0.061, P < 0.001) over time, achieving stable phase within 3 months from the initiation of PPS treatment. For UFM parameters, postvoid residual decreased significantly over time (−1.052, P = 0.029), while maximum flow rate (0.093, P = 0.334) and voiding volume (0.751, P = 0.586) showed no significant differences. Compared to patients older than 65 years, those younger than 65 years showed significantly better improvements in the IPSS (−0.492 vs. −0.184, P = 0.018) but worse in voiding volume (−2.481 vs. 5.032, P = 0.006). PPS provides clinical benefits in urinary symptoms voiding symptoms and QoL over time, arriving plateau within 3 months. Such benefits based on the IPSS tend to be more evident in younger patients, suggesting that PPS mostly benefits early treatment if suspected for IC/BPS.

Park HJ, et al. Investig Clin Urol. 2026 Sep;67(5):452-458. https://doi.org/10.4111/icu.20260093

Jong Ho Park, Seok-Soo Byun. Theater Endourol. Robot. 2026;2:26-30. https://doi.org/10.64364/tier.26.0010

Background/Objectives: While robot-assisted radical cystectomy (RARC) is widely adopted, its long-term survival impact relative to open radical cystectomy (ORC) remains uncertain. We compared survival outcomes between ORC and RARC using a propensity score-matched multicenter cohort. Methods: We retrospectively analyzed 3972 radical cystectomy patients from 11 Korean tertiary centers between 2003 and 2024. After stratifying by surgical approach (ORC vs. RARC), 1:1 propensity score matching (PSM) mitigated baseline imbalances. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were evaluated using Kaplan–Meier and multivariable Cox analyses. Results: PSM yielded 473 well-balanced patients per group. Compared to ORC, RARC was associated with a longer operative time but demonstrated a superior perioperative profile, including reduced estimated blood loss, lower intraoperative transfusion rates, shorter hospital stays, higher lymph node yields, and lower positive margin rates. RARC significantly improved OS (5-year: 75.4% vs. 56.1%; 10-year: 68.3% vs. 44.5%; p < 0.001) and CSS (5-year: 88.1% vs. 71.6%; 10-year: 82.7% vs. 67.7%; p < 0.001), with comparable RFS (5-year: 59.6% vs. 54.8%; 10-year: 51.1% vs. 47.4%; p = 0.155). Multivariable analyses confirmed RARC as an independent predictor of improved OS (hazard ratio [HR] 0.564, p < 0.001) and CSS (HR 0.474, p < 0.001). Conclusions: RARC demonstrated superior perioperative outcomes and favorable survival trends compared to ORC, with no difference in RFS. Although RARC appears to be an oncologically safe alternative, these exploratory survival benefits require cautious interpretation due to potential residual confounding. Further prospective validation is warranted.