{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T08:51:11Z","timestamp":1766825471844,"version":"3.48.0"},"reference-count":0,"publisher":"PAGEPress Publications","issue":"4","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Purpose: BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) remains a persistent challenge. This study examines Romanian urologists\u2019 clinical practices, focusing on treatment preferences and awareness of emerging therapies for BCG-unresponsive disease. Methods: A cross-sectional, web-based survey comprising 24 items was distributed to selected urologists who manage NMIBC via professional mailing lists. Data were collected between May 15 and June 30, 2025. Results: Out of 400 invited urologists, 216 completed the survey. Radical cystectomy (RC) was the most preferred treatment for BCG-unresponsive NMIBC, recommended by 67% of respondents, followed by tumor resection with surveillance (15%), repeat BCG instillation (14%), and intravesical chemotherapy (4%). Neither clinical trials nor intravenous checkpoint inhibitors were used. Among those using intravesical chemotherapy, gemcitabine was the most commonly used agent (85%), followed by mitomycin C (5%), gemcitabine\/docetaxel (4%), gemcitabine\/ mitomycin C (3%), docetaxel (2%), and valrubicin (1%). Oncological safety concerns were the main barrier to adopting bladder-sparing therapies. Awareness of FDA-approved therapies for BCG-unresponsive disease, Nadofaragene firadenovec, Nogapendekin alfa inbakicept-pmln, and Pembrolizumab, was limited; 61% of urologists were unaware of all three, and only 1% had used any. BCG shortages were reported by 93% of respondents at some point, who adapted by reducing doses and prioritizing high-grade T1 and CIS cases. Most recognized intravesical chemotherapy as an alternative and were willing to use it if needed. Conclusions: Though RC remains the predominant approach for BCG-unresponsive cases, over half of urologists\u2019 report using intravesical chemotherapy, reflecting interest in bladder-sparing strategies rather than newly approved FDA agents.<\/jats:p>","DOI":"10.4081\/aiua.2025.14596","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T08:47:52Z","timestamp":1766825272000},"source":"Crossref","is-referenced-by-count":0,"title":["A national perspective on the management of high-risk BCG-unresponsive non-muscle-invasive bladder cancer in Romania"],"prefix":"10.4081","volume":"97","author":[{"given":"Maximilian","family":"Buzoianu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan Adrian","family":"Buhas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Abou Chakra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuela","family":"Ionutas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihnea Bogdan","family":"Borz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolae","family":"Crisan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A","family":"O'Donnell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2025,12,24]]},"container-title":["Archivio Italiano di Urologia e Andrologia"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14596\/13618","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/download\/14596\/13618","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T08:47:52Z","timestamp":1766825272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/aiua\/article\/view\/14596"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,24]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12,24]]}},"URL":"https:\/\/doi.org\/10.4081\/aiua.2025.14596","relation":{},"ISSN":["2282-4197","1124-3562"],"issn-type":[{"value":"2282-4197","type":"electronic"},{"value":"1124-3562","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,24]]}}}