Muscle-invasive bladder cancer (MIBC) poses a significant clinical challenge because of its poor prognosis, with a 5-year survival rate seldom exceeding 50% to 60% [1]. The standard and widely accepted treatment for MIBC is radical cystectomy [2]. Bimanual palpation (examination under anesthesia, EUA) represents an integral part of clinical bladder cancer staging, as outlined by the guidelines [2,3]. In clinical practice, EUA, although primarily used for staging purposes, offers a unique opportunity beyond assessing clinical disease stage. Specifically, it enables the evaluation of bladder mobility and its potential impact on resectability, an aspect that has garnered limited attention in the existing medical literature. Currently, clinical decisions regarding whether to proceed with radical cystectomy are predominantly based on cross-sectional imaging. However, the accuracy of such assessments can be uncertain. An incorrect evaluation of resectability may have serious consequences, as unresectable bladder cancer leads to a dismal prognosis due to the inevitable disease spread. Research pertaining to bladder resectability remains sparse; hence, well-established criteria for its evaluation are lacking.

In the evolving landscape of bladder cancer management, studies continually contribute to a deeper understanding of systemic treatments for advanced bladder carcinoma [4], [5], [6], [7]. These investigations explore novel therapies and the intricacies of immunotherapy, providing valuable insights into potential avenues for the treatment of advanced bladder cancer. Notably, a discernible trend in urologic oncology indicates that systemic therapies, once reserved primarily for advanced metastatic disease, demonstrate efficacy in earlier disease stages. This paradigm shift underscores the need to reassess traditional treatment approaches to bladder cancer. Despite advancements in systemic treatments, however, the assessment of bladder resectability, a critical aspect of MIBC management, remains an understudied domain.

Pathological features are unavailable until after surgery and cannot guide operative decisions. There is therefore a need in urologic oncology, so far unmet to identify effective tools for assessing resectability preoperatively, with the goal of optimizing surgical outcomes and patient care.

To the best of the authors’ knowledge, no studies have examined the role of EUA in assessing bladder resectability. Thus, in this study, we aimed to prospectively evaluate the value of EUA in the assessment of bladder resectability during cystectomy.