Non-muscle-invasive Bladder Cancer


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 multidisciplinary 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:

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 2022 [4]. All documents are accessible through the EAU website Uroweb:

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 2024 NMIBC Guidelines present a limited update of the 2023 publication.

1.4.2. Summary of changes

For the 2024 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 category of high-grade recurrence during or after BCG (table 7.2): the BCG-exposed tumour category;
  • updates on the proposed treatment options for late BCG relapses and low grade (LG) recurrence after bacillus Calmette-Guérin (BCG) for primary intermediate-risk bladder cancer in table 7.3;
  • a proposed follow-up schedule based on patient’s risk category in Table 8.2;
  • a new section on patient reported outcome measures and quality indicators for NMIBC (section 9).

In addition, minor adaptions and updates to multiple recommendations have been made and users are advised to review all sections in full. A summary of key recommendation changes include:

  • an update in the evidence and guidelines in section 4.10 on bladder cancer classification;
  • new summary of evidence and recommendations updates in section 5.15 on the transurethral resection of the bladder, biopsies and pathology report;
  • guidelines updates in section 7.10 on adjuvant therapy in TaT1 tumours and for therapy of carcinoma in situ;
  • a new update to the very high risk EAU risk group, in section 7.11 on the guidelines for the treatment of TaT1 tumours and carcinoma in situ according to risk stratification;
  • new updates in section 8.2 on the summary of evidence and recommendations for the follow-up of patients after transurethral resection of the bladder for non-muscle-invasive bladder cancer.