EAU Guidelines on Nonmuscle-invasive Bladder Cancer (TaT1 and CIS) - A Summary of the 2026 Guidelines Update
- Study type
- Clinical guideline
- Study name
- EAU NMIBC 2026
- Design
- Clinical guideline based on a structured review of the evidence (MEDLINE, EMBASE, Cochrane) with grading of recommendation strength (strong/weak)
- Source
- Eur Urol · 2026
In plain words
Most bladder cancers (about three-quarters) have not yet reached the muscle layer when they are diagnosed. This guideline explains how the diagnosis is made by cystoscopy and removing the tumour through the urethra (TURBT), how patients are divided into four groups by risk of progression (low, intermediate, high and very high), and how additional treatment inside the bladder (a single dose of chemotherapy, courses of chemotherapy or the BCG vaccine) and the schedule of follow-up cystoscopies are decided on this basis. Stopping smoking is recommended for all patients who smoke.
Key guideline recommendations
- Strong
Perform cystoscopy, with or without biopsy confirmation, in patients with symptoms suspicious of bladder cancer; cystoscopy cannot be replaced by cytology or any other non-invasive test. Use renal and bladder ultrasound and/or CT urography in the initial work-up of patients with haematuria.
- Strong
Use urine cytology as an adjunct to cystoscopy to detect high-grade tumour.
- Strong
Perform transurethral resection of bladder tumour (TURBT) followed by pathological examination of the specimen(s) as a diagnostic procedure and the first step of treatment in patients suspected of having bladder cancer.
- Strong
Perform a second TURBT in these cases: after incomplete initial TURBT or if there is doubt about its completeness; if there is no detrusor muscle in the specimen after initial resection (except Ta LG/G1 tumours and primary CIS); or in T1 tumours.
- Strong
Stratify patients with NMIBC into four risk groups by the probability of progression without BCG treatment; a patient's risk group can be determined with the EAU 2021 risk group calculator at www.nmibc.net.
- Strong
Advise patients who smoke to stop smoking.
- Strong
Low-risk group: offer one immediate instillation of intravesical chemotherapy after TURBT. Intermediate-risk group: in most patients, intravesical chemotherapy (optimal schedule unknown) is a reasonable first-line option, and one year of full-dose BCG (induction plus three weekly instillations at months 3, 6 and 12) is an alternative.
- Strong
High-risk group: offer full-dose intravesical BCG for one to three years, but also discuss immediate radical cystectomy with the patient. Very high-risk group: radical cystectomy or full-dose intravesical BCG for one to three years, especially for patients who decline or are unfit for cystectomy.
- Strong
Discuss with the patient the benefits and harms of adding sasanlimab and durvalumab to BCG with maintenance in selected BCG-naïve patients with high-risk and very high-risk NMIBC.
- Strong / Weak for bladder-sparing strategies
Offer radical cystectomy to patients with BCG-unresponsive tumours. For patients who are not candidates for cystectomy because of comorbidities or who decline it, offer bladder-sparing strategies (intravesical chemotherapy, chemotherapy with microwave-induced hyperthermia, electromotive drug administration of chemotherapy, intravesical or systemic immunotherapy; preferably within a clinical trial).
- Strong / Weak for the schedule
Base follow-up of TaT1 tumours and CIS on regular cystoscopy. In high-risk and very high-risk patients, repeat cystoscopy and urine cytology at the third month and, if negative, every three months for two years, then every six months until five years, and yearly lifelong thereafter.
Study population
Patients with non-muscle-invasive bladder cancer (NMIBC) including Ta and T1 tumours and carcinoma in situ (CIS) of urothelial carcinoma type.
Clinical significance and place in guidelines
The EAU guideline is the main European reference for managing NMIBC and bases treatment choice on the EAU 2021 risk groups (calculator at www.nmibc.net). The recommendations below are taken from the full text of the 2026 guideline (March 2026 update) on the EAU website, of which this paper is a summary.
Limitations
The published paper is a summary of the guideline, and full details are in the guideline text on the EAU website. Many follow-up recommendations rest on retrospective data. Access to BCG is limited in some countries.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.