Abstract Urinary biomarkers have long promised to reduce the cystoscopy burden in bladder cancer, but a persistent gap separates assay performance from clinical practice. This review synthesizes the shift from protein-based tests to multiplex, genomic, and extracellular-vesicle liquid biopsies, including minimal residual disease detection and therapy selection, and sets out an implementation roadmap spanning pre-analytical standardization, decision thresholds, and pragmatic trial design.
