Guidelines

Muscle-invasive and Metastatic Bladder Cancer

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2. Methods

2. METHODS

2.1. Data identification

For the 2023 MIBC Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the MIBC Guideline was performed. The search was limited to English language publications. Databases searched included Medline, EMBASE and the Cochrane Libraries, covering a time frame between June 11th, 2021 and May 4th 2022. A total of 1,197 unique records were identified, retrieved and screened for relevance resulting in 76 new publications having been included in the 2023 print. A detailed search strategy is available online: https://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic/?type=appendices-publications.

For each recommendation within the guidelines there is an accompanying online strength rating form which includes the assessment of the benefit to harms ratio and patients‘ preferences for each recommendation. The strength rating forms draw on the guiding principles of the GRADE methodology but do not purport to be GRADE [5,6]. These forms address a number of key elements namely:

  1. the overall quality of the evidence which exists for the recommendation, references used in this text are grade according to a classification system modified from the Oxford Centre for Evidence-Based Medicine Levels of Evidence [7];
  2. the magnitude of the effect (individual or combined effects);
  3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
  4. the balance between desirable and undesirable outcomes;
  5. the impact of patient values and preferences on the intervention;
  6. the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’ [8]. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and nature and variability of patient values and preferences.

Additional information can be found in the general Methodology section of this print, and online at the EAU website; http://www.uroweb.org/guideline/.

A list of Associations endorsing the EAU Guidelines can also be viewed online at the above address.

The results of a collaborative multi-stakeholder consensus project on the management of advanced- and histological subtypes BC have been incorporated in the MIBC Guidelines update in 2020 [9,10].

2.2. Future goals

Topics considered for inclusion in the 2024 update of the MIBC Guidelines:

  • Development of a diagnostic pathway for the assessment of visible and nonvisible haematuria;
  • Development of an evidence-based strategy for functional- and oncological follow-up of patients treated for MIBC;
  • Participation in developing strategies to ensure meaningful participation of patients in the development and implementation of the MIBC Guidelines.