Management of Bladder Cancer During Pregnancy: A Narrative Review

Bladder cancer (BC) during pregnancy is extremely rare. Therefore, the epidemiological understanding of BC during pregnancy remains limited, and the literature consists mostly of isolated case reports. This review aimed to provide an updated, comprehensive overview of the incidence, risk factors, and clinical management of BC during pregnancy, based on published case reports and the literature.

A literature search was performed on 1st July 2025 using PubMed, EMBASE, and Google Scholar with no date limit. The following terms were used: "bladder cancer", "urothelial carcinoma", "bladder tumor", "treatment", "management", "pregnancy", "pregnant women" and "therapy". Finally, 18 articles were included.

Pregnancy introduces a complex clinical scenario, where overlapping symptoms can complicate diagnosis. While hematuria may often be attributed to benign pregnancy-related causes, persistent or unexplained presentations should prompt further assessment to exclude underlying malignancy. Cystoscopy remains the gold standard for diagnosing BC, offering direct visualization and the possibility of biopsy. However, it is an invasive procedure and is associated with potential discomfort and complications, which can be particularly concerning during pregnancy. Non-invasive techniques, such as ultrasound and magnetic resonance imaging, are preferred for diagnostic evaluation as they minimize radiation exposure and are generally considered safe in pregnancy.

The treatment of BC during pregnancy poses a significant clinical challenge, requiring a delicate balance between optimizing maternal outcomes and ensuring fetal safety. Therapeutic decisions are largely guided by two key factors: the gestational age at diagnosis and the clinical stage of the tumor. Radical surgical interventions and systemic therapies are generally contraindicated during pregnancy due to potential risks to the fetus. Therefore, a conservative approach is often adopted, aiming to contain disease progression while minimizing harm to the developing fetus.