For the 2025 Non-muscle-invasive Bladder Cancer 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 recommendations to section 5.9 related to the timing of MRI for local staging of bladder cancer. In addition, in section 5.9 the recommendation on the use of flexible cystoscope in men and women has also been updated.
- A new section, section 6.3, on histological subtypes has been added to the guideline including Table 6.1 which outlines subtype prognostic factors and risk of progression.
- Section 7.9.2 “Recurrence during or after intravesical BCG therapy” has been restructured to more clearly present the definitions of BCG failure and the treatment options for BCG-unresponsive tumours.
- Adaption of the recommendation on active surveillance in section 7.10.
- Significant adaption and expansion of section 8.1.5.4 “Urinary molecular markers” including the inclusion of a new table on the performance of multiplex urine markers in the surveillance setting.
- Addition of a new section, section 10, on pragmatic de-intensification strategy for NMIBC.