Non-muscle-invasive bladder cancer (NMIBC) is an early-stage cancer without invasion into the detrusor muscle layer. Transurethral resection of bladder tumour (TURBT) is a diagnostic and potentially curative procedure for NMIBC, but has some limitations, including difficulties in ascertaining complete tumour removal upon piecemeal resection and the possibility of tumour re-implantation after the procedure. The oncological control of NMIBC is far from satisfactory, with a 1-year recurrence rate of 15-61%, and a 5-year recurrence rate of 31-78%. Various recurrence mechanisms have been described for NMIBC, such as undetected tumours upon cystoscopy, incomplete resection during TURBT, tumour re-implantation after TURBT, drop metastasis from upper tract urothelial carcinoma and field change cancerization. Understanding the recurrence mechanisms from a clinical perspective has strong implications for the optimization of NMIBC oncological outcomes, as a cure for patients with NMIBC can only be achieved by tackling all possible recurrence mechanisms in a comprehensive manner.

Department of Urologic Sciences University of British Columbia Vancouver British Columbia Canada

Department of Urology 2nd Faculty of Medicine Hospital Motol Charles University Prague Czech Republic

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Division of Oncology Department of Medicine University of Washington Washington USA

European Association of Urology Young Academic Urologists Urothelial Cancer Working Group Amsterdam Netherlands

Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Seattle WA USA

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

S H Ho Urology Centre Department of Surgery The Chinese University of Hong Kong Hong Kong China

The University of Texas MD Anderson Cancer Center Houston TX USA

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