Stesura Seveso Archivio Italiano di Urologia e Andrologia 2025; 97(2):13455 1 ORIGINAL PAPER nosed cases respectively (3-6). BCa treatment depends on the tumor type and stage: neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy with pelvic lymph node dissections is considered the gold standard treatment for MIBC, eventually associated to adjuvant plat- inum-based combined chemotherapy (7). In the metastatic setting combined method of chemothera- py, immunotherapy and targeted therapy can be used, but despite their therapeutic efficacy, they are characterized by several side effects and toxicity (8). BCa has a high impact on the quality of life (QoL) of patients and partners. Nowadays, mobile applications (apps) represent a tool to support health behavior and provide medical information and/or management of different disease (9-12). Apps can be downloaded from “Play Store” for Android and “App Store” for iOS. Nowadays their number is constantly grow- ing, however despite this their quality assessments are still a problem. To avoid this, in the last years, a valid tool called Mobile Application Rating Scale (MARS) has been developed. The second issue related to MHA is their adherence to guidelines. To the best of our knowledge, there are no stud- ies reporting the quality of apps for BCa and their adher- ence to guidelines. The aim of this study is to evaluate the quality and the adherence to guidelines of MHA developed to assist patients affected by BCa. MATERIALS AND METHODS Search strategy We performed an observational cross-sectional descriptive study of all smartphone apps for patients about BC avail- able on the iOS and Android platforms and evaluated their adherence to EAU guidelines. On 24 Sep 2024, we con- Introduction: Mobile health applications (MHAs) represent a tool to assist patients affected by different disease including bladder cancer (BCa), although the scientific quality and adherence to guidelines are not yet addressed. Material and methods: On September 2024, we conducted a search in the Apple App Store and Google Play Store. We reviewed all mobile apps from Apple App Store and Google Play Store for BC and evaluated their usage in screening, pre- vention, management, and adherence to EAU guidelines. Results: In total 10 MHA were reviewed. All MHAs are geared towards the patient and provide information about diagnoses and treatment of BC. The mean score was 3.29 in Engagement, 3.26 in Functionality, 3.06 in Aesthetics, 3.13 in Information, and 3 in Subjective quality respectively. MHAs reported low and medium adherence to EAU guidelines. Conclusions: MHAs provide different services in many medical fields, including BCa. There are several drawbacks regarding scientific validation, content, and quality. Future research is necessary to promote new user designed, and high-quality apps. KEY WORDS: Keywords: App; E-health; Mobile phone; Bladder cancer; MARS. Submitted 5 December 2024; Accepted 21 December 2024 INTRODUCTION Bladder cancer (BCa) represents one of the ten most diag- nosed cancer worldwide with an incidence of 550.000 new cases per years and more than 200,000 deaths (1, 2). BCa is classified into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) depending on the cellular infiltration of cancer cells in the muscular layer. NMIB and MIBC accounts for 75% and 25% of newly diag- Analysis and adherence to guidelines of mobile health application for bladder cancer, where are we? Roberto La Rocca 1, Ernesto Di Mauro 1, Alfonso Falcone 1, Enrico Sicignano 1, Luigi Cirillo 1, Pasquale Reccia 2, Lorenzo Romano 3, Michelangelo Olivetta 4, Gennaro Mattiello 5, Felice Crocetto 1, Biagio Barone 6, Luigi De Luca 7, Ugo Amicuzi 1, Francesco Mastrangelo 1, Carmine Turco 8, Corrado Aniello Franzese 9, Ferdinando Fusco 3, Davide Arcaniolo 3, Vincenzo Maria Altieri 10, Luigi Napolitano 11 1 Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy; 2 Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy; 3 Department of Woman, Child and General and Specialized Surgery, Unit of Urology, University of Campania "Luigi Vanvitelli", Naples, Italy; 4 Urology Unit, Gaetano Fucito Hospital, AOU San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Italy; 5 Division of Urology, Department of Surgical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy; 6 Department of Urology, ASL NA1 Centro, P.O. San Paolo, Naples, Italy; 7 Division of Urology, Department of Surgical Multispecialty, AORN Antonio Cardarelli, Naples, Italy; 8 Department of Urology, ASL NA1 Centro Ospedale del Mare, Naples, Italy; 9 ASL Napoli 3 Sud, Naples, Italy; 10 Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy; 11 ASL Salerno, Salerno, Italy. DOI: 10.4081/aiua.2025.13455 Summary Archivio Italiano di Urologia e Andrologia 2025; 97(2):13455 R. La Rocca, E. Di Mauro, A. Falcone, et al. 2 ducted a search in Google Play Store for Android phones and Apple App Store for iPhones with the keywords ‘blad- der cancer’, ‘bladder cancer treatment’ and ‘bladder cancer diagnosis’ using the search tab. We used a wide array of keywords due to the search strategy of Google Play Store and Apple App Store which is based on finding keywords in titles, app descriptions and tags. Other searches of information provided in books or other formats were excluded. Two authors (A.F., E.D.M.) screened separately in App Store and Google Play Store apps during the search by reading the title and description in the app store. A third author (L.N.) resolved any discrepancies. At the beginning all apps were reported in Excel form and, according to the exclusion criteria, were screened. All MHAs regarding BCa, providing a service to patients, in English, and free to download were included in this analy- sis. Apps not specifically focused on BCa, apps not allow- ing access to all users and those not available in English were excluded. Successively, all reviewers downloaded and installed the apps on their personal mobile device. They interacted for twenty minutes with each app to explore its features before completing the MARS and eval- uating their adherence to EAU guidelines. To assess apps, they were downloaded to either an Android or an IOS device. If apps were available in both app stores, the iOS version was assessed. According to criteria used in similar studies, raters gave each app a score from 0 to 3 for each of the five items. A score of ‘‘0’’ indicated no adherence to guidelines. A score of ‘‘1’’ indicated a weak adherence. A score of ‘‘2’’ indicated a partial or moderate adherence. A score of ‘‘3’’ indicated strong adherence. Where coding scores differed by 1 point, the average of the two ratings was taken. If there was a greater than 1-point discrepancy, a third author (a full professor) reviewed apps and resolved the discrepancy. The possible score on the checklist ranged from 0 to 15 for each app. To facilitate evaluation, adherence to the checklist was arbitrarily considered low with a total score ranging from 0 to 5, medium (6-10), and high (10-15). A total of 78 apps were found by our search, of them 73 were from the Google Play Store (Android) and 5 of them were from the Apple App Store (iOS). Of the total, 72 apps were screened after removing duplicates and paid apps. Of the total screened apps, 62 apps met excluding criteria and were removed. One app resulted in both stores. In total, 10 apps were eligible for the final evaluation and were down- loaded. A flow diagram based on the PRISMA statement (Figure 1) was included for the selected apps (13). Figure 1. PRISMA. Archivio Italiano di Urologia e Andrologia 2025; 97(2):13455 3 Guidelines of mobile health application for bladder cancer Table 1 shows the analyzed apps characteristics. The BC apps were evaluated by four members of the research team on a 5-point Likert scale based on MARS character- istics. Data extraction On 30 October 2024 reviewers, according to previous studies modality created a predefined Excel form to col- lect data. The following data were extracted from MHA: title, language, customers, costs, source (Google Play Store or Apple App Store), field/disease, rating/feedback from the users and service provided. Assessment of app quality and app adherence to EAU guidelines Mobile Application Rating Scale (MARS), and an adherence checklist of five items (definition, physiopathology, diag- nosis, risk factors and treatment) based on EAU guide- lines were used to assess the MHA quality and guidelines adherence as reported in our previous studies RESULTS In total 10 apps were included in the final analysis: 9 MHA were in the Google Play Store, and one from Apple store. All apps provided information about treatment, 9 apps provided information about diagnosis. Bladder can- cer risk factors were mentioned in 9 MHA as well. Data about downloads were available for all MHA. The most downloaded app was Medscape in which more than five million of downloads were reported. All the apps were planned to be used by patients. Rating was available only for 5 apps. Cumulative MARS scale scores are represent- ed in Table 2. Engagement The score in this section was based on a 5-point Likert scale in 5 subscales (Entertainment, Interest, Customization, Interactivity and Target-group). The mean score was 3.29. Scores ranged from 1.4 to 4.3 out of 5. The “Manual of Clinical Oncology” app (Android) produced by “Unbond Medicine, Inc.” received the highest score for the engagement. This app contains interactive features for management and prevention of bladder cancer. It also contains information about surgical management, with EAU tutorial videos explaining several surgical tech- niques. Functionality The score of the functionality section was based on a 5- point Likert scale in 4 subscales (Performance, Ease of use, Navigation and Gestural design) and the mean score was 3.26. Scores ranged from 1.5 to 4.6. “Manual of Clinical Oncology” app (Apple iOS/Android) achieved the maxi- mum score. Aesthetics The aesthetics section was formed by a 5-point Likert scale in 3 subscales (Layout, Graphics, Visual Appeal) and the average score was 3.06. Scores ranged from 1 to 4.6 out of 5 and “Medscape” app produced by “WebMD, LLC” reached the maximum aesthetic score. Table 1. Apps characteristics. Name of application Download Rating Producer Category BCAN Bladder Cancer App 100+ n.a. Bladder Cancer Advocacy Network Health and Fitness NCCN Patients Guides for Cancer 10.000+ n.a. National Comprehensive Cancer Network Medicine ONCOassist 10.000+ 4.5 Portable Medical Technology Ltd. Medicine Outcomes4Me Cancer Care 100.000+ n.a. Outcomes4Me Inc. Health and Fitness ESMO Interactive Guidelines 10.000+ 4.2 European Society for Medical Oncology Medicine Medscape 5 MLN+ 4.7 WebMD, LLC Medicine Manual of Clinical Oncology 10.000+ n.a. Unbond Medicine, Inc. Medicine Diseases Dictionary Oflline 1 MLN + 4.4 Ufostudio Medicine Diseases Treatment Dictionary 500.000+ 4.9 Smart Training Medicine Symptom Checker 5000+ n.a. FriendsApp Listing Medicine Table 2. MARS scale. APP Engagment Functionally Aesthetic Information Subjective quality APP quality mean score section A section B Section C Section D Section E (A+B+C+D) BCAN Bladder Cancer App 3.6 3.3 3 3.4 3 3.3 NCCN Patients Guides for Cancer 4 4 3.7 3.3 3 3.7 ONCOassist 1.6 1.7 2 1.6 2 1.7 Outcomes4Me Cancer Care 4 4.2 3.7 3.7 3 3.9 ESMO Interactive Guidelines 4.2 4 4.3 4.3 4 4.2 Medscape 4.2 4 4.6 4.3 4 4.3 Manual of Clinical Oncology 4.3 4.6 4 4.3 4 4.3 Diseases Dictionary Oflline 3.6 3.3 3 3.4 3 3.3 Diseases Treatment Dictionary 2 2 1.3 2 2 1.8 Symptom Checker 1.4 1.5 1 1 2 1.2 Archivio Italiano di Urologia e Andrologia 2025; 97(2):13455 R. La Rocca, E. Di Mauro, A. Falcone, et al. 4 Information The information section was formed by a 5-point Likert scale in 7 subscales and the mean score was 3.13. Score ranged from 1 to 4.3. Three apps, “ESMO Interactive Guidelines” produced by “European Society for Medical Oncology”, “Medscape” and “Manual of clinical oncology”, reached the highest score in Information. Subjective quality The subjective quality section consisted of 4 items. The mean score was 3, with scores ranging from 2 to 4. “ESMO Interactive Guidelines”, “Medscape” and “Manual of clinical oncology” apps reached the maximum score. EAU adherence checklist We evaluated the EAU guidelines adherence in 10 apps. EAU adherence scores are represented in Table 3. The BC definition was reported in 10 (100%) apps; phys- iopathology was reported in 9 (90%) apps; risk factors were reported in 9 (90%) apps; diagnosis was reported in 9 (90%) apps; treatment was reported in 10 (100%) apps. The maximum achievable score of 15 was reported by “NCCN Patients Guides for Cancer”, “Outcomes4Me Cancer Care”, “ESMO Interactive Guidelines”, “Medscape” and “Manual of Clinical Oncology” apps. DISCUSSION This study represents the first attempt to evaluate the quality of MHAs designed for BCa and their adherence to EAU guidelines. The findings provide valuable insights into the limitations and potential of these digital tools in supporting Bca patients. Several key observations emerge from our analysis, shedding light on both challenges and opportunities in utilizing MHAs for this patient popula- tion. The overall quality of MHAs for Bca, as evaluated by the Mobile Application Rating Scale (MARS), was higher than data from previous studies evaluating MHAs for other health conditions. Mean scores for categories such as “Information,” “Aesthetics” and “Functionality” were 3.13, 3.06, and 3.26, respectively, reflecting good per- formance in areas critical to user engagement, learning and utility. Interestingly, MHAs that achieved higher scores in these categories were those developed with direct involvement of healthcare professional support. This finding aligns with prior research emphasizing the importance of interdisciplinary collaboration in creating effective and reliable digital tools (14-15). For instance, Weiss et al. successfully developed an MHA designed to provide education, symptom tracking, and alerts for patients undergoing radical cystectomy. Their findings demonstrated the app’s feasibility, acceptability, and edu- cational value, particularly in helping patients manage postoperative symptoms (16). Similarly, other studies, such as those by Tolstrup et al. and Huelster et al., high- light the benefits of MHAs co-developed with multidisci- plinary teams. Tolstrup et al. implemented a national mul- timodality app for Bca patients that enables symptom monitoring, provides self-management advice, and facili- tates communication during clinical encounters (17). Huelster et al. explored the use of a mobile app combined with biometric monitoring to capture patient-reported symptoms and identify complications after radical cystec- tomy, demonstrating the potential of these tools to improve clinical outcomes (18). Another notable example is the work by Metcalf et al. which highlighted the feasi- bility of using a healthcare application to provide periop- erative education and monitoring for patients undergoing radical cystectomy. In this pilot study, the app delivered educational content, such as detailed explanations of sur- gical options and postoperative care pathways, while monitoring patients through wearable devices (19). Such examples demonstrate how MHAs, when thoughtfully designed, can bridge significant gaps in patient education and postoperative care. The role of MHAs extends beyond patient education and support to include contri- butions to research and data collection. Smittenaar et al. demonstrated the feasibility of using crowdsourcing with- in an MHA to analyze immunostained cancer samples for biomarker discovery. This innovative approach under- scores the versatility of MHAs not only as tools for patient care but also as platforms for advancing scientific research. The ability to engage patients in generating valuable clinical data highlights a dual role for these applications in improving individual outcomes and con- tributing to broader scientific understanding (12, 20). Despite these promising examples, our study reveals sig- nificant gaps in the current landscape of MHAs for Bca. A major concern is the lack of adherence to EAU guidelines, with less than one-third of the analyzed apps addressing essential topics such as Bca definition, pathophysiology, risk factors, diagnosis, and treatment. Table 3. Adherence to EAU guidelines. Title Definition Pathophysiology Risk factors Diagnosys Treatment (0-3) 0-3) (0-3) (0-3) (0-3) BCAN Bladder Cancer App 2 2 3 2 2 NCCN Patients Guides for Cancer 3 3 3 3 3 ONCOassist 2 1 0 1 2 Outcomes4Me Cancer Care 3 3 3 3 3 ESMO Interactive Guidelines 3 3 3 3 3 Medscape 3 3 3 3 3 Manual of Clinical Oncology 3 3 3 3 3 Diseases Dictionary Oflline 2 2 3 2 2 Diseases Treatment Dictionary 2 3 2 2 2 Symptom Checker 1 0 1 0 2 Archivio Italiano di Urologia e Andrologia 2025; 97(2):13455 5 Guidelines of mobile health application for bladder cancer This deficiency raises concerns about the reliability of these apps as educational resources and their potential to disseminate incomplete or misleading information. Adherence to clinical guidelines must be a foundational requirement for all MHAs to ensure they provide credi- ble, accurate, and actionable information. Notably, some apps have successfully integrated guideline-driven con- tent. For example, Beardo et al. developed APPv, an MHA specifically designed for the treatment and follow-up of NMIBC. In a prospective study, APPv demonstrated a 64% con- cordance rate with urologist-prescribed treatments, with higher agreement in low-risk cases (77%) compared to high-risk cases (17%). Importantly, patients who adhered to treatment recommendations via APPv had significantly better outcomes, with 89.1% remaining recurrence-free compared to 61.1% in cases of disagreement. This exam- ple underscores the potential of MHAs to improve adher- ence to treatment guidelines and enhance clinical out- comes when they are aligned with evidence-based prac- tices (21). The challenges faced by Bca patients, including navigating complex treatment pathways, managing post- operative symptoms, and coping with the psychological burden of the disease, further emphasize the need for well-designed MHAs (22, 23). These tools have immense potential to bridge gaps in education and support, empowering patients to better understand their condition and make informed decisions. However, the current shortcomings in quality, usability, and adherence to clin- ical guidelines undermine this potential. Addressing these challenges requires a multifaceted approach. First, part- nerships with clinical experts and healthcare institutions are crucial for the co-development of MHAs that are evi- dence-based and patient-centered. Collaboration with professionals ensures that these tools reflect the latest medical standards and adequately address the specific needs of Bca patients. Incorporating expert-reviewed con- tent and designing features that align with real-world clinical scenarios can significantly enhance the credibility and utility of MHAs (12, 25-25). Second, the promotion of standardized quality assessment frameworks, such as MARS, is vital for improving the overall quality of MHAs (12, 26). These frameworks should be integrated into both the development and evaluation processes, enabling systematic assessment of app performance, usability, and content accuracy (27). Regular use of MARS can help developers identify and address shortcomings early, ensuring that final products meet high standards of qual- ity and reliability (28). Third, content accuracy must be prioritized by adhering comprehensively to EAU or equivalent guidelines. Developers should focus on creat- ing comprehensive, guideline-driven content to ensure that patients receive accurate and actionable information. This step is particularly important given the complexity of Bca treatment pathways and the need for patients to make informed decisions about their care (29). Lastly, user engagement is a critical determinant of an MHA’s success. Incorporating interactive and personalized fea- tures, such as symptom tracking, treatment reminders, and tailored educational content, can make these tools more appealing and better suited to the diverse needs of Bca patients (30). Additionally, feedback mechanisms can help developers refine app features based on user preferences and experi- ences, further enhancing their effectiveness. Expanding research efforts to evaluate the real-world impact of MHAs is also essential for their continued development and refinement. Longitudinal studies focusing on out- comes such as treatment adherence, quality of life, patient satisfaction, and clinical results will provide valuable insights into the effectiveness of these tools. This research can inform the development of new features and functionalities that address unmet patient needs, ulti- mately driving the evolution of MHAs into indispensable resources for Bca care. CONCLUSIONS This study represents a significant first step in evaluating the quality and adherence to clinical guidelines of MHAs designed for Bca patients. The findings highlight the cur- rent limitations of these digital tools, particularly in terms of their quality and adherence to EAU guidelines. Despite the growing number of MHAs available, most of the apps analyzed demonstrated suboptimal performance, with low MARS scores in key categories such as information, aesthetics, and functionality. Furthermore, less than one- third of the apps adhered to essential Bca guidelines, rais- ing concerns about their reliability and potential impact on patient care. While some apps showed promise by integrating guide- line-driven content, the overall landscape remains under- developed, with significant gaps in content accuracy and usability. To fully harness the potential of MHAs in sup- porting Bca patients, it is essential to prioritize partner- ships with healthcare professionals to ensure that these tools are evidence-based, user-friendly, and aligned with clinical standards. Standardized quality assessment frameworks like MARS should be consistently applied during both development and evaluation stages to ensure high-quality outputs. Future efforts should focus on refining content accuracy, enhancing user engagement, and conducting real-world evaluations of MHAs’ impact on patient outcomes, such as treatment adherence and quality of life. By addressing these challenges, MHAs have the potential to become indispensable resources for Bca care, improving patient education, clinical outcomes, and overall healthcare experiences for patients facing this challenging disease. REFERENCES 1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68:394- 424. Erratum in: CA Cancer J Clin. 2020; 70:313. 2. Sridhar SS. Evolving Treatment of Advanced Urothelial Cancer. J Oncol Pract. 2017; 13:309-315. 3. Becker REN, Meyer AR, Brant A, et al. Clinical Restaging and Tumor Sequencing are Inaccurate Indicators of Response to Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer. Eur Urol. 2021; 79:364-371. Archivio Italiano di Urologia e Andrologia 2025; 97(2):13455 R. La Rocca, E. Di Mauro, A. Falcone, et al. 6 4. Knowles MA, Hurst CD. Molecular biology of bladder cancer: new insights into pathogenesis and clinical diversity. Nat Rev Cancer. 2015; 15:25-41. 5. Barone B, Napolitano L, Reccia P, et al. Preoperative Fibrinogen-to- Albumin Ratio as Potential Predictor of Bladder Cancer: A Monocentric Retrospective Study. Medicina (Kaunas). 2022; 58:1490. 6. Brooks NA, O'Donnell MA. Combination Intravesical Therapy. Urol Clin North Am. 2020; 47:83-91. 7. Alfred Witjes J, Max Bruins H, Carrión A, et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol. 2024; 85:17-31. Erratum in: Eur Urol. 2024; 85:e180. 8. Tagawa ST, Balar AV, Petrylak DP, et al. TROPHY-U-01: a Phase II Open-Label Study of Sacituzumab Govitecan in Patients With Metastatic Urothelial Carcinoma Progressing After Platinum- Based Chemotherapy and Checkpoint Inhibitors. J Clin Oncol. 2021; 39:2474-2485. 9. Cirillo L, Manfredi C, Barone B, et al. Mobile health applications in kidney stone disease management: A reliable support for patients? Arch Ital Urol Androl. 2023; 95:11076. 10. Fusco GM, Cirillo L, Abate M, et al. Male infertility, what Mobile Health Applications "know": quality analysis and adherence to European Association of Urology Guidelines. Arch Ital Urol Androl. 2022; 94:470-475. 11. Napolitano L, Cirillo L, Fusco GM, et al. Premature ejaculation in the era of mobile health application: A current analysis and eval- uation of adherence to EAU guidelines. Arch Ital Urol Androl. 2022; 94:328-333. 12. Napolitano L, Fusco GM, Cirillo L, et al. Erectile dysfunction and mobile phone applications: Quality, content and adherence to European Association guidelines on male sexual dysfunction. Arch Ital Urol Androl. 2022; 94:211-216. 13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. 14. Weiss K, Abimbola O, Mueller D, et al. Feasibility, Acceptability, and Outcomes of a Mobile Health Tool for Radical Cystectomy Recovery. J Urol. 2024; 211:266-275. 15. Tolstrup LK, Als AB, Carus A, et al. The iBLAD app protocol - a national, exploratory study on a multimodality smartphone app in bladder cancer for better understanding symptoms, quality of life and need for supportive care. Acta Oncol. 2023; 62:329-333. 16. Huelster HL, Zemp L, Turner K, et al. Mobile Postoperative Symptom Intervention Tool and Biometric Monitoring After Radical Cystectomy: Pilot Study Evaluating Feasibility, Usability, and Potential Utility. J Urol. 2023; 209:410-421. 17. Metcalf M, Glazyrine V, Glavin K, et al. The Feasibility of a Health Care Application in the Treatment of Patients Undergoing Radical Cystectomy. J Urol. 2019; 201:902-908. 18. Smittenaar P, Walker AK, McGill S, et al. Harnessing citizen sci- ence through mobile phone technology to screen for immunohisto- chemical biomarkers in bladder cancer. Br J Cancer. 2018; 119:220- 229. 19. Beardo P, Pinto R, Ayerra H, et al. Optimizing treatment for non muscle-invasive bladder cancer with an app. Actas Urol Esp (Engl Ed). 2022; 46:230-237. 20. Catto JWF, Downing A, Mason S, et al. Quality of Life After Bladder Cancer: A Cross-sectional Survey of Patient-reported Outcomes. Eur Urol. 2021; 79:621-632. 21. Barone B, Napolitano L, Reccia P, et al. Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction-A Comprehensive Review. J Pers Med. 2024; 14:392. 22. Mannino RG, Arconada Alvarez SJ, Greenleaf M, et al. Navigating the complexities of mobile medical app development from idea to launch, a guide for clinicians and biomedical researchers. BMC Med. 2023; 21:109. 23. Siegler AJ, Knox J, Bauermeister JA, et al. Mobile app develop- ment in health research: pitfalls and solutions. Mhealth. 2021; 7:32. 24. Deniz-Garcia A, Fabelo H, Rodriguez-Almeida AJ, et al. Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges. J Med Internet Res. 2023; 25:e44030. 25. Giebel GD, Speckemeier C, Schrader NF, et al. Quality Assessment of mHealth Apps: A Scoping Review. Front. Health Serv. 2024; 4:1372871. 26. Stoyanov SR, Hides L, Kavanagh DJ, et al. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth. 2015; 3:e27. 27. Alfred Witjes J, Max Bruins H, Carrión A, et al. European Association of Urology Guidelines on Muscle-Invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol. 2024; 85:17-31. 28. Oakley-Girvan I, Yunis R, Longmire M, Ouillon JS. What Works Best to Engage Participants in Mobile App Interventions and E- Health: A Scoping Review. Telemed. J. E Health 2022; 28:768. 29. Amor-García MÁ, Collado-Borrell R, Escudero-Vilaplana V, et al. DECLARATIONS Ethical approval: Not applicable. Consent for publication: Not applicable. Availability of data and material: The datasets used and/or analyzed during the current study are available upon reason- able request from the corresponding author. Competing interests: The authors declare that they have no competing interests. Funding: This research received no external funding. Authors' contributions: EDM, AF, ES, LC, PR, LR, MO, GM, FC, BB, LDL: data analysis and interpretation, RLR, VMA, LN: study concept ,manuscript original drafting; BB, UA:statis- tical analyses, FM, CT, histological examination, CAF, FF, DA: contribution to manuscript writing and editing. All the authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work. Acknowledgments: Not applicable. Archivio Italiano di Urologia e Andrologia 2025; 97(2):13455 7 Guidelines of mobile health application for bladder cancer Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis. JMIR MHealth UHealth 2020; 8:e17609. 30. Raphael J, Trudeau ME, Chan K. Outcome of patients with preg- nancy during or after breast cancer: a review of the recent literature. Curr Oncol. 2015; 22(Suppl 1):S8-S18. Correspondence Roberto La Rocca - robertolarocca87@gmail.com Ernesto Di Mauro - ernestodm9@gmail.com Alfonso Falcone - alfonso.falcone01@gmail.com Enrico Sicignano - enrisici90@gmail.com Luigi Cirillo - cirilloluigi22@gmail.com Felice Crocetto - felice.crocetto@gmail.com Ugo Amicuzi - U.amicuzi@gmail.com Francesco Mastrangelo Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 80138 Naples, Italy Pasquale Reccia - reccia.pasquale1@gmail.com Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy Lorenzo Romano - loryromano@hotmail.it Ferdinando Fusco - ferdinando-fusco@libero.it Davide Arcaniolo - davide.arcaniolo@unicampania.it Department of Woman, Child and General and Specialized Surgery, Unit of Urology, University of Campania "Luigi Vanvitelli", Naples, Italy Michelangelo Olivetta - Olivetta.drmichelangelo@gmail.com Urology Unit, Gaetano Fucito Hospital, AOU San Giovanni di Dio e Ruggi d'Aragona, 84085 Mercato San Severino, Italy Gennaro Mattiello - drmattiellogennaro@gmail.com Division of Urology, Department of Surgical Sciences, AORN Sant'Anna e San Sebastiano, 81100 Caserta, Italy Biagio Barone - biagio193@gmail.com Department of Urology, ASL NA1 Centro, P.O. San Paolo, 80125 Naples, Italy Luigi De Luca - luigideluca86@gmail.com Division of Urology, Department of Surgical Multispecialty, AORN Antonio Cardarelli, 80131 Naples, Italy Carmine Turco - car.turco87@gmail.com Department of Urology, ASL NA1 Centro Ospedale del Mare, 80147 Naples, Italy Corrado Aniello Franzese - corradofranzese@libero.it ASL Napoli 3 Sud, Naples Vincenzo Maria Altieri - vincenzomaria.altieri@gmail.com Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy Luigi Napolitano - dr.luiginapolitano@gmail.com ASL Salerno, Salerno, Italy