Guidelines

Non-muscle-invasive Bladder Cancer

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2. METHODS

2.1 Data identification

For the 2026 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 carried out. Databases searched included Medline, EMBASE and the Cochrane Libraries, covering a time frame between 1 May 2024 and 1 May 2025. A total of 773 unique records were identified, retrieved and screened for relevance. To ensure completeness, a number of key studies published after the predefined search cut-off date were also included. A total of 64 new references were added to the 2026 NMIBC Guidelines. A detailed search strategy is available online: https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer/publications-appendices.

The references used in Chapters 3 through 6 have been assessed according to their level of evidence (LE) based on the 2009 Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence [4]. For Chapters 7, ‘Disease management,’ and 8, ‘Follow-up of patients with NMIBC,’ a system modified from the 2009 CEBM levels of evidence has been used [4].

Recommendations within the Guidelines are developed by the Panels to prioritise clinically important care decisions. 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 the nature and variability of patient values and preferences. This decision process, which can be reviewed in the strength rating forms that accompany each guidelines recommendation, addresses a number of key elements:

  1. the overall quality of the evidence that exists for the recommendation [4];
  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; and
  5. the impact and certainty of patient values and preferences on the intervention.

Strong recommendations typically indicate a high degree of evidence quality and/or a favourable balance of benefit to harm and patient preference. Weak recommendations typically indicate availability of lower quality evidence and/or equivocal balance between benefit and harm, and uncertainty or variability of patient preference [5].

Additional methodology information and a list of associations endorsing the EAU Guidelines can be found online: https://uroweb.org/eau-guidelines/methodology-policies.

2.2. Review

The 2026 publication was peer reviewed prior to publication.