Muscle-invasive and Metastatic Bladder Cancer


1.1. Aims and scope

The European Association of Urology (EAU) Guidelines Panel for Muscle-invasive and Metastatic Bladder Cancer (MIBC) have prepared these guidelines to help urologists assess the evidence-based management of MIBC and to incorporate guideline recommendations into their clinical practice.

Separate EAU guidelines are available addressing upper urinary tract (UUT) tumours [1], non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ) (NMIBC) [2], and primary urethral carcinomas [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 consists of an international multidisciplinary group of clinicians, including urologists, oncologists, a pathologist, a radiologist, radiotherapists and patient representatives.

Section 5.3 - MIBC and health status, was developed with the assistance of Prof.Dr. S. O’Hanlon, consultant geriatrician, International Society of Geriatric Oncology (SIOG) representative and member of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Prostate Cancer Guidelines Panel. The MIBC Panel is most grateful for his support.

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:

1.3. Available publications

A quick reference document (Pocket Guidelines) is available. This is an abridged version which may require consultation together with the full text version.

Several scientific publications are available (the most recent paper dating back to 2021 [4], as are a number of translations of all versions of the EAU MIBC Guidelines. All documents are accessible through the EAU website:

1.4. Publication history and summary of changes

1.4.1. Publication history

The EAU published its first guidelines on bladder cancer (BC) in 2000. This document covered both NMIBC and MIBC. Since these conditions require different treatment strategies, it was decided to give each condition its own guidelines, resulting in the first publication of separate MIBC Guidelines in 2004. This 2023 document presents a limited update of the 2022 version.

1.4.2. Summary of changes

New relevant references have been identified through a structured assessment of the literature and incorporated in the various chapters of the 2023 EAU MIBC Guidelines resulting in new sections added:

  • Section 5.2 Imaging for staging of MIBC, was restructured
  • Section 7.3 Radical cystectomy: technique and extent, was restructured
  • In Section 7.2.3 the following was added to the Summary of evidence
Summary of evidence and guidelines for pre- and post-operative radiotherapy

Summary of evidence


Limited evidence supports the safe use of pre- and post-operative radiotherapy in case a neobladder is planned or in situ.


Figure 7.1 Flow chart for the management of T2–T4a N0M0 urothelial bladder cancer, has been updated