Bladder Cancer Management in Brazil's Supplementary Health System: Real-World Practice Patterns.

PURPOSE: The objective of the present study was to evaluate real-world practices of Brazilian urologists regarding bladder cancer management within the supplementary healthcare system. MATERIALS AND METHODS: A cross-sectional, survey-based study was conducted among Brazilian urologists. A structured questionnaire assessed demographics, practice characteristics, and management strategies for non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC). Data were collected during the 2025 Brazilian Congress of Urology and via electronic distribution. Descriptive statistics were used, and exploratory comparisons were performed. RESULTS: A total of 914 urologists from 25 federative units (24 states and the federal district) participated in the study. Cystoscopy was nearly universal (93.8%), but access to enhanced imaging (17.9%) and office-based flexible cystoscopy (19.3%) was limited. In NMIBC, most urologists maintained patient care (82.9%), but management was heterogeneous. Immediate postoperative intravesical chemotherapy was rarely used. Bacillus Calmette-Guérin (BCG) was prescribed in most cases of recently treated NMIBC by 39.3% of respondents, while 54.2% referred patients for administration. Although 74.5% reported access to it, only 14.3% had availability for all patients. Preference flow analysis showed BCG as the main first-line therapy (65.4%), intravesical chemotherapy as second-line (51.2%), and pembrolizumab (31.3%) and radical cystectomy (30.2%) as third-line options. Radical cystectomy is annually performed by 65.1% of respondents; however, most reported low annual volumes, with 95% performing fewer than ten cases per year. CONCLUSIONS: Bladder cancer management in the Brazilian supplementary healthcare system is heterogeneous, with important gaps in access, technology availability, and adherence to recommended practices. Despite limitations inherited to survey-based research, including potential selection bias, reliance on self-reported data, and possible overlap between public and private practice settings, these findings highlight opportunities for educational initiatives and system-level improvements.