Non-muscle-invasive Bladder Cancer


2.1. Data Identification

For the 2022 NMIBC Guidelines, new and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature. A broad and comprehensive scoping exercise covering all areas of the NMIBC Guidelines was performed. Excluded from the search were basic research studies, case series, reports, and editorial comments. Only articles published in the English language, addressing adults, were included. The search was restricted to articles published between June 3rd 2021 and May 4th 2022. Databases covered by the search included Pubmed, Ovid, EMBASE and the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. After deduplication, a total of 825 unique records were identified, retrieved, and screened for relevance. A total of 72 new references were added to the 2023 NMIBC Guidelines. A detailed search strategy is available online:

For Chapters 3 through 6 (Epidemiology, Aetiology and Pathology, Staging and Classification systems, Diagnosis, Predicting disease recurrence and progression) the references used in this text were assessed according to their level of evidence (LE) based on the 2009 Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence [9]. For the Disease Management and Follow-up chapters (Chapters 7 and 8) a system modified from the 2009 CEBM levels of evidence was used [9].

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 [10,11]. Each strength rating form addresses a number of key elements namely:

  1. the overall quality of the evidence which exists for the recommendation [9];
  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’ [12]. 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; A list of associations endorsing the EAU Guidelines can also be viewed online at the above address.

2.2. Review

The 2021 publication was peer reviewed prior to print.

2.3. Future goals

The findings of the ongoing ‘Individual Patient Data Validation of the Definition of bacillus Calmette-Guérin (BCG) Failure/BCG Unresponsive in Patients with Non-muscle Invasive Urothelial Carcinoma of the Bladder: an international multicentre retrospective study’ will be included in the future update of the NMIBC Guidelines.