This publication represents a summary of the updated 2026 European Association of Urology (EAU) Guidelines for nonmuscle-invasive bladder cancer (NMIBC), TaT1 and carcinoma in situ (CIS). The information presented herein is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC, with a focus on clinical presentation.
For the 2026 guidelines on NMIBC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included MEDLINE, EMBASE, and the Cochrane Library. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences.
Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with NMIBC. The guidelines stress the importance of defining patients' risk stratification and treating them appropriately. Key updates in the 2026 NMIBC Guidelines summary include: the addition of two new tables addressing risk factors for bladder cancer and prognostic factors for progression in subtypes; the addition of two new tables summarising the treatment options for Bacillus Calmette-Guérin (BCG)-unresponsive tumours; inclusion of a new section addressing the addition of immune checkpoint inhibitors to BCG in selected high- and very high-risk NMIBC BCG-NAÏVE patients; a new table addressing the role of urinary markers in follow-up; and the addition of a new section on pragmatic de-intensification strategy for NMIBC.
This overview of the 2026 EAU guidelines offers valuable insights into risk factors, diagnosis, classification, prognostic factors, treatment, and follow-up of NMIBC. They are designed for effective integration into clinical practice.
The EAU has issued updated clinical practice guidelines on NMIBC. The guidelines provide recommendations for diagnosis, treatment, and follow-up, with a particular focus on quality of life for patients.
European urology. 2026 Jul 15 [Epub ahead of print]
Paolo Gontero, Paramananthan Mariappan, Benjamin Pradere, Bhavan P Rai, Fredrik Liedberg, Eva Compérat, Jeremy Yuen-Chun Teoh, Marco Moschini, Francesco Soria, Bas W G van Rhijn, Joyce Baard, Alison Birtle, Maresa Botha, Otakar Capoun, David D'Andrea, Edoardo Fiorini, Alexandra Masson-Lecomte, Thomas Seisen, Shahrokh F Shariat, Emma J Smith, Viktor Soukup, Robert Wood, Evanguelos N Xylinas, José L Dominguez-Escrig
Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy., Edinburgh Bladder Cancer Surgery (EBCS), The University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom., Department of Urology UROSUD, La Croix du Sud Hospital, Quint-Fonsegrives, France., Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK., Institute of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden., Department of Pathology, Medical University of Vienna, Vienna, Austria., S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong., Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom., EAU Guidelines Office, Arnhem, the Netherlands., Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic., Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria., Associazione PaLiNUro, Milan, Italy., Department of Urology, Université de Paris, APHP, Saint Louis Hospital, Paris, France., GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France., EAU Guidelines Office, Arnhem, the Netherlands. Electronic address: ., Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France., Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain.