Background: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 70–75% 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–October 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) (>80–100 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–Guérin (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.
背景：非肌层浸润性膀胱癌约占新诊断膀胱癌的70–75%，其特点是在遵循指南管理的情况下仍具有高复发率。慢性尿潴留和膀胱出口梗阻被认为是影响NMIBC预后的潜在因素，其机制可能涉及长期暴露于尿液致癌物、炎症反应以及膀胱内药代动力学的改变。本叙述性综述定性综合了膀胱出口梗阻相关功能障碍与NMIBC生物学行为关联的生物学及临床证据，并探讨了前列腺钬激光剜除术作为功能性辅助治疗在特定患者中初步显现的作用。 方法：本综述依据SANRA指南进行。在PubMed/MEDLINE、Embase和Scopus数据库（2000年1月至2025年10月）中，使用预定义的NMIBC、膀胱出口梗阻、尿潴留及前列腺钬激光剜除术相关术语进行检索。由两名评审员独立筛选文献，分歧通过协商一致解决。最终纳入61项研究。 结果：在不同异质性队列中，残余尿量升高（>80–100 mL）和中重度下尿路症状与更高的NMIBC复发率持续相关，且独立于肿瘤分期和分级。尿潴留与卡介苗和丝裂霉素C疗效降低相关，这可能源于药物分布不均和慢性炎症性尿路上皮。机制研究支持膀胱出口梗阻相关炎症、屏障功能障碍与肿瘤生物学之间存在合理关联，但尚缺乏与残余尿量直接相关的生物标志物证据或药代动力学研究。前列腺钬激光剜除术能持久缓解膀胱出口梗阻、减少残余尿量并改善下尿路症状。有限的回顾性数据显示该手术可能与较低复发率相关，但这些观察结果存在混杂因素，应视为假设生成性结论。 结论：慢性尿潴留和膀胱出口梗阻似乎是可干预的功能性因素，可能影响NMIBC复发和膀胱内治疗的效果。对于经严格筛选的患者，前列腺钬激光剜除术是优化膀胱排空的有前景的选择，但其肿瘤学影响尚未证实，在获得前瞻性风险校正研究结果前，应将其视为假设生成性观点。
肿瘤(癌症)患者之家