Guidelines recommend radical cystectomy for high-risk non-muscle-invasive bladder cancer that fails BCG, yet real-world uptake is unclear. This multinational physician survey captured practice across eight countries and 2,583 patients.

Radical cystectomy was used in only about 7 to 8% of patients with recurrent high-risk disease across successive treatment lines, and physicians judged roughly a quarter to be likely future surgical candidates. Among BCG-treated patients offered cystectomy, 68% refused, citing quality-of-life concerns (87%), unwillingness to have a stoma (60%) and surgical safety worries (37%).

The message is less about surgical technique than about patient-centred reality: a guideline-recommended operation is frequently declined, so the practical gap is the lack of effective bladder-preserving alternatives. For clinic, it reinforces honest shared decision-making about cystectomy's impact and the value of newer intravesical and systemic options where cystectomy is refused or unsuitable.

Multinational survey of 359 physicians and 2,583 high-risk non-muscle-invasive bladder cancer patients.
Radical cystectomy was used in only about 7 to 8% of recurrent high-risk cases.
Of BCG-treated patients offered cystectomy, 68% refused.
The commonest reasons were quality of life (87%), stoma avoidance (60%) and safety concerns (37%).
The gap highlights the need for effective bladder-preserving treatments.

Why it matters

It reframes the BCG-unresponsive bladder cancer problem as partly one of acceptability, not just efficacy, which is where new bladder-sparing therapies matter.

The statistics, in plain English

This is a cross-sectional, physician-reported survey describing practice patterns and preferences, not outcomes, so it quantifies what happens and why patients decline, but cannot say whether refusal worsens survival.