Diagnostic Performance of Urinary Biomarker Tests in Detecting Bladder Cancer: A Systematic Review, Meta-analysis, and Network Meta-analysis

OBJECTIVE: To assess the diagnostic estimates of current urine-based diagnostic bladder tests for diagnosing bladder cancer using diagnostic test accuracy (DTA) and network meta-analysis (NMA). METHODS: The search for this systematic review and meta-analysis was conducted on PubMed and Medline for relevant studies published until September 30, 2025. The meta-analysis and network meta-analysis were performed using a random-effect model, to compute the pooled sensitivity and specificity of the markers. The qualitative synthesis included 122 studies comprising 24,252 patients. RESULTS: In most studies, there was an unclear risk of bias in the setting of evaluating de novo and recurrent bladder cancer. Novel urine-based assays demonstrated promising diagnostic values with pooled sensitivity upto 90% and specificity upto 92%. The NMA revealed that diagnostic values of the novel urine-based assays were significantly higher than those of cytology for detecting bladder cancer. CONCLUSION: Over the past decade, several new urine-based bladder cancer detection assays have become commercially available. Our analysis supports a high diagnostic accuracy of the newer urine-based bladder cancer detection tests for evaluating bladder cancer. PROSPERO REGISTRATION: CRD420251134193.