{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:43:55Z","timestamp":1790963035275,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 70\u201375% of newly diagnosed bladder cancers and is characterized by high recurrence rates despite guideline-based management. Chronic urinary retention and bladder outlet obstruction (BOO) have been proposed as under-recognized modifiers of NMIBC outcomes through prolonged exposure to urinary carcinogens, inflammation, and altered intravesical pharmacokinetics. This narrative review qualitatively synthesizes biological and clinical evidence linking BOO-related dysfunction with NMIBC behavior and explores the emerging, but preliminary, role of Holmium Laser Enucleation of the Prostate (HoLEP) as a functional adjunct in selected patients. Methods: A narrative review was conducted according to SANRA guidelines. PubMed\/MEDLINE, Embase, and Scopus were searched (January 2000\u2013October 2025) using predefined terms for NMIBC, BOO, urinary retention, and HoLEP. Two reviewers independently screened records, with disagreements resolved by consensus. Sixty-one studies met inclusion criteria. Results: Elevated postvoid residual (PVR) (&gt;80\u2013100 mL) and moderate to severe lower urinary tract symptoms (LUTS) were consistently associated with higher NMIBC recurrence rates, independent of tumor stage and grade, in heterogeneous cohorts. Retention correlated with reduced efficacy of Bacillus Calmette\u2013Gu\u00e9rin (BCG) and mitomycin C, likely via uneven drug distribution and a chronically inflamed urothelium. Mechanistic data support a plausible link between BOO-related inflammation, barrier dysfunction, and tumor biology, although direct biomarker correlations with PVR or pharmacokinetic studies are lacking. HoLEP provides durable relief of BOO, reduces PVR, and improves LUTS. Limited retrospective data suggest an association between HoLEP and lower recurrence, but these observations are confounded and should be viewed as hypothesis-generating. Conclusions: Chronic urinary retention and BOO appear to be modifiable functional factors that may influence NMIBC recurrence and intravesical therapy performance. HoLEP is a promising option to optimize bladder emptying in carefully selected patients, but its oncologic impact remains unproven and should be considered hypothesis-generating pending prospective, risk-adjusted studies.<\/jats:p>","DOI":"10.3390\/cancers17233864","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T11:29:30Z","timestamp":1764761370000},"page":"3864","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Rationale and Emerging Evidence on the Potential Role of HoLEP-Mediated Relief of Bladder Outlet Obstruction in NMIBC Outcomes Through Optimal Management of Chronic Urinary Retention"],"prefix":"10.3390","volume":"17","author":[{"given":"Angelo","family":"Porreca","sequence":"first","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2908-6907","authenticated-orcid":false,"given":"Filippo","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"De Marchi","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Giampaoli","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"D\u2019Agostino","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8387-8290","authenticated-orcid":false,"given":"Francesca","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Ragonese","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2730-0402","authenticated-orcid":false,"given":"Antonio","family":"Amodeo","sequence":"additional","affiliation":[{"name":"Department of Oncological Urology, Veneto Institute of Oncology (IOV)\u2014IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Corsi","sequence":"additional","affiliation":[{"name":"Department of Oncological Urology, Veneto Institute of Oncology (IOV)\u2014IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Claps","sequence":"additional","affiliation":[{"name":"Department of Oncological Urology, Veneto Institute of Oncology (IOV)\u2014IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0564-7415","authenticated-orcid":false,"given":"Luca","family":"Di Gianfrancesco","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.eururo.2021.08.010","article-title":"European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1, and Carcinoma in Situ)","volume":"81","author":"Babjuk","year":"2022","journal-title":"Eur. 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