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 (UC), unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation. Separate EAU Guidelines 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 references/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 multi-disciplinary group of clinicians, including urologists, uro-oncologists, a pathologist, and a patient representative. 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/guidelines/non-muscle-invasive-bladder-cancer/panel.
1.3. Available publications
A quick reference document, the Pocket Guidelines, is available in print. This is an abridged version which may require consultation together with the full text version. Several scientific publications are available, the latest publication dating to 2024 [4]. All documents are accessible through the EAU website Uroweb: https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer. A EAU Guidelines App for iOS and Android devices is also available containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, guidelines cheat sheets and links to the extended guidelines.
1.4. Publication history and summary of changes
1.4.1. Publication history
The EAU Guidelines on Bladder Cancer were first published in 2000. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates This 2025 NMIBC Guidelines present a limited update of the 2024 publication.
1.4.2. Summary of changes
For the 2025 NMIBC Guidelines new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. This resulted in the inclusion of 36 updated studies across the Guidelines. Key changes include:
- The addition of a new recommendations to Section 5.9 related to the timing of MRI for local staging of bladder cancer. In addition, in Section 5.9 the recommendation on the use of flexible cystoscope in men and women has also been updated.
- A new section, Section 6.3, on histological subtypes has been added to the guideline including Table 6.1 which outlines subtype prognostic factors and risk of progression.
- Section 7.9.2 “Recurrence during or after intravesical BCG therapy” has been restructured to more clearly present the definitions of BCG failure and the treatment options for BCG-unresponsive tumours.
- Adaption of the recommendation on active surveillance in Section 7.10.
- Significant adaption and expansion of Section 8.1.5.4 “Urinary molecular markers” including the inclusion of a new table on the performance of multiplex urine markers in the surveillance setting.
- Addition of a new section, Section 10, on pragmatic de-intensification strategy for NMIBC.