Urinary Biomarkers and Their Role in the Management of Urothelial Carcinoma: A Narrative Review

Background: Urothelial carcinoma requires frequent surveillance because of its high recurrence rate, particularly in patients with non-muscle-invasive disease. Although cystoscopy remains the standard method for diagnosis and follow-up, it is invasive, costly, and associated with patient discomfort. Urinary biomarkers have emerged as potential tools for improving surveillance and reducing unnecessary cystoscopies. Methods: We performed a narrative review of studies published between 2017 and 2026 evaluating urinary biomarkers in urothelial carcinoma. Particular attention was given to assay mechanisms, diagnostic performance, clinical applications, and integration into surveillance techniques. Results: The most extensively studied biomarkers were Xpert Bladder Cancer Monitor, Bladder EpiCheck, ADXBLADDER, and Cxbladder. Most molecular assays demonstrated higher sensitivity than urinary cytology, particularly for the detection of high-grade recurrence. Reported negative predictive values frequently exceeded 95%, suggesting potential utility in identifying patients at low risk of clinically significant recurrence. Xpert Bladder Cancer Monitor and Bladder EpiCheck were supported by the largest body of surveillance evidence, whereas Cxbladder and mutation-enhanced platforms showed promise for risk stratification and individualized follow-up. Evidence supports the use of urinary biomarkers as adjuncts to cystoscopy rather than replacements. Conclusions: Modern urinary biomarkers provide clinically useful information during the surveillance of urothelial carcinoma, especially for excluding high-grade recurrence and assisting the interpretation of equivocal findings. Future biomarker-guided surveillance strategies may reduce the burden of cystoscopy while maintaining oncological safety. Further studies are required to improve specificity and sensitivity in order to fully integrate these biomarkers into diagnostic and follow-up protocols.