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This requires risk stratification\u2013based postoperative management, such as intravesical instillation of chemotherapy drugs, Bacillus Calmette\u2013Gu\u00e9rin (BCG), and radical cystectomy. Advancements in mechanical engineering, molecular biology, and surgical skills have evolved the clinical management of NMIBC. In this review, we describe the updated evidence and perspectives regarding the following aspects: (1) advancements in surgical concepts, techniques, and devices for transurethral resection of the bladder tumor; (2) advancements in risk stratification tools for NMIBC; and (3) advancements in treatment strategies for BCG\u2010treated NMIBC. Repeat transurethral resection, en\u2010bloc transurethral resection, and enhanced tumor visualization, including photodynamic diagnosis and narrow\u2010band imaging, help reduce residual cancer cells, provide accurate diagnosis and staging, and sensitive detection, which are the first essential steps for cancer cure. Risk stratification should always be updated and improved because the treatment strategy changes over time. The BCG\u2010treated disease concept has recently diversified to include BCG failure, resistance, refractory, unresponsiveness, exposure, and intolerance. A BCG\u2010unresponsive disease is an extremely aggressive subset unlikely to respond to a rechallenge with BCG. Numerous ongoing clinical trials aim to develop a future bladder\u2010sparing approach for very high\u2010risk BCG\u2010na\u00efve NMIBC and BCG\u2010unresponsive NMIBC. The key to improving the quality of patient care lies in the continuous efforts to overcome the clinical limitations of bedside management.<\/jats:p>","DOI":"10.1111\/iju.15263","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T08:26:53Z","timestamp":1690792013000},"page":"944-957","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Recent advancements in the diagnosis and treatment of non\u2010muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, and\n                    <scp>BCG<\/scp>\n                    \u2010treated disease"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9503-7356","authenticated-orcid":false,"given":"Makito","family":"Miyake","sequence":"first","affiliation":[{"name":"Department of Urology Nara Medical University Nara 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