Non-muscle-invasive Bladder Cancer

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

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M. Babjuk (Chair), M. Burger (Vice-Chair), E. Compérat, P. Gontero, A.H. Mostafid, J. Palou, B.W.G. van Rhijn, M. Rouprêt, S.F. Shariat, R. Sylvester, R. Zigeuner
Guidelines Associates: O. Capoun, D. Cohen, V. Hernández, V. Soukup

1.INTRODUCTION

1.1.Aim and scope

This overview represents the updated European Association of Urology (EAU) Guidelines for Non-muscle-invasive Bladder Cancer (NMIBC), TaT1 and carcinoma in situ (CIS). The information presented is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations.

Separate EAU Guidelines documents are available addressing upper tract urothelial carcinoma (UTUC) [1], muscle-invasive and metastatic bladder cancer (MIBC) [2], and primary urethral carcinoma [3]. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The EAU Guidelines Panel on NMIBC consists of an international multidisciplinary group of clinicians, including urologists, uro-oncologists, a pathologist and a statistician. Members of this Panel have been selected based on their expertise and to represent the professionals treating patients suspected of suffering from bladder cancer. All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website Uroweb: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available, both in print and as an app for iOS and Android devices. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available, the latest publication dating to 2016 [4], as are a number of translations of all versions of the EAU NMIBC Guidelines. All documents are accessible through the EAU website Uroweb: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The EAU Guidelines on Bladder Cancer were first published in 2000. This 2018 NMIBC Guidelines document presents a limited update of the 2017 publication.

1.4.2.Summary of changes

Additional data has been included in sections:

  • 4.4 4.4 - Histological grading of non-muscle-invasive bladder urothelial carcinomas
  • 5.11.1 - Photodynamic diagnosis (fluorescence cystoscopy);
  • 5.12 - Second resection;
  • 7.2.1.3.2 - Device-assisted intravesical chemotherapy.

New recommendations have been added to:

  • Section 5.9 - Summary of evidence and guidelines for the primary assessment of non-muscle-invasive bladder cancer

Recommendations

Strength rating

In men, use flexible cystoscope, if available.

Strong

Describe all macroscopic features of the tumour (site, size, number and appearance) and mucosal abnormalities during cystoscopy. Use a bladder diagram (Figure 5.1).

Strong

Use the Paris system for cytology reporting.

Strong

  • Section 5.14 - Summary of evidence and guidelines for transurethral resection of the bladder, biopsies and pathology report

Recommendations

Strength rating

Performance of individual steps

Use methods to improve tumour visualization (FC, NBI) during TURB, if available.

Weak

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