A new clinical nodal staging score (cNSS) has been designed to help determine the minimum number of lymph nodes to remove at radical cystectomy in order to ensure true nodal status in patients with refractory non-muscle-invasive and muscle-invasive bladder cancer. Shariat et al. devised the system based on retrospective data from over 4,000 patients across 12 centers. The cNSS provides the probability that a pathologic N0 status is accurate as a function of the number of nodes examined. For example, in a patient with stage cT2 cancer, the cNSS predicts a >90% probability of determining true nodal status if 25 lymph nodes are removed.