General Inclusion Criteria:

• Adults over the age of 18

• Ability to engage in the informed consent process or have an appropriate representative available to do so

• All prior therapies allowed (NAC, XRT, intravesical treatment, etc.)

• Caprini Risk Score ≤10 (to account for subtracting the active index bladder cancer being treated)

ARM A-TURBT Arm

• Suspected or known de novo tumor of the bladder based on cystoscopy and/or imaging

• Planned to undergo TURBT for a de novo bladder tumor 

• Individuals who have a history of NMIBC with now a new tumor that has not been addressed yet (TURBT or biopsy) are eligible

ARM B-Radical Cystectomy Arm-Prior Systemic Therapy

• Suspected or known tumor of the bladder based on cystoscopy, imaging, prior procedures and tissue sampling

• Planned to undergo radical cystectomy for treatment of bladder cancer

• History of (some) prior systemic therapy for bladder cancer-this includes traditional chemotherapy and/or treatments such as immunotherapy or antibody drug conjugates

• Intravesical treatments for bladder cancer only do not qualify patients for this arm

ARM C-Radical Cystectomy Arm-No Prior Systemic Therapy

• Suspected or known tumor of the bladder based on cystoscopy, imaging, prior procedures and tissue sampling

• Planned to undergo radical cystectomy for treatment of bladder cancer

• No history of (any) prior systemic therapy for bladder cancer-patients who have received intravesical treatments for bladder cancer only are eligible for this arm though

General Exclusion Criteria:

• Inability to provide informed consent or an individual from a vulnerable population

• Anatomic alteration or pathology that prevents retrograde access to bladder with bronchoscope (ex. closed bladder neck)

• Prior major bladder reconstruction that alters the native makeup of the bladder wall such as in enteric bladder augmentation

• Caprini Risk score of > 11

  • Prescreening

  • And allowing screen fail-out at time of surgery (after POE)

• Active urinary tract infection not including suspected colonization

• If the patient is such a poor general anesthetic (GA) candidate that they require spinal anesthesia, then they would not qualify for this study

• Any significant medical history that would pose an unreasonable risk for TUR or make the subject unsuitable for the study

• Subject is considered vulnerable such as incarcerated or cognitively impaired

ARM A-TURBT Arm

• Prior resection of the tumor in question (i.e. not a de novo tumor)

• Prior systemic therapy or radiation for bladder cancer

ARM B-Radical Cystectomy Arm-Prior Systemic Therapy

• Radical cystectomy as part of other operation or not for a bladder cancer primary (known prior to surgery)

• No prior systemic therapy for bladder cancer (see arm C)

ARM C-Radical Cystectomy Arm-No Prior Systemic Therapy

• Radical cystectomy as part of other operation or not for a bladder cancer primary (known prior to surgery)

• Prior systemic therapy for bladder cancer (see arm B)

Note: Other protocol defined Inclusion/Exclusion Criteria may apply.

Eligibility last updated 03/18/2026. Questions regarding updates should be directed to the study team contact.