For the 2026 guidelines update new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the guidelines. The guidelines text has been carefully reviewed and updated accordingly. The recommendations have been reviewed in full and reworked to aid practical implementation. Specific changes include:
- 5.1 Contraindications for intravesical instillations - The categorisation of UTI as localised UTI (e.g. “cystitis”) or systemic UTI according to the 2025 EAU Guidelines of Urological Infections: www.uroweb.org/guidelines/urological-infections.
- 10.1 Patient assessment - Prior to both initial and subsequent administrations of intravesical therapy, patients must be assessed before and after each instillation, focusing on overall health status and symptoms indicative of UTI. Dip-stick testing alone is not recommended for ruling out UTI. Clinical evaluation is essential to avoid unnecessary antibiotic use, thereby supporting antibiotic stewardship and reducing the risk of antimicrobial resistance.
- 10.2 Pre-procedure nutrition - Consistent evidence has established the critical role of nutrition as the fourth pillar in cancer care. Despite evidence showing that integrating adequate nutritional care into standard cancer care, positively impacts relevant clinical outcomes; health related quality of life (HRQoL) and reduction of toxicities or complications, there remain limited studies of the impact of nutrition in NMIBC.
- 12 Patient Quality of Life - There is an emerging understanding of the impact on HRQoL on NMIBC cancer treatment. Systematic reviews have found that NMIBC patients have a substantial symptom and functional burden that impacts HRQoL throughout the induction period of treatment but returns to baseline level by the end of the maintenance period of treatment. New longitudinal data also document that HRQoL is comparable with that of the general population after four years.
- 13 Patient experience - Patient experience is added to this update acknowledging that patient experience and preferences are important to facilitate adherence to treatment.