The AUA and SUO have issued the 2026 update to their guideline on non-muscle-invasive bladder cancer. The systematic search covered Ovid MEDLINE and Embase for evidence published between May 2023 and December 2025, with added search terms for newly available therapeutic agents; 2,933 studies were screened, 71 met initial criteria and 38 formed the final evidence base.
Updates were made across the framework rather than in one place: risk stratification itself, biomarkers, subtype histologies, transurethral resection, intravesical therapy, BCG maintenance and enhanced cystoscopy.
The risk stratification change is the one that propagates. Everything downstream in NMIBC — how often you cystoscope, whether the patient gets BCG, whether induction is followed by maintenance, when you start discussing cystectomy — hangs off which risk group the patient is in. A revised stratification means patients already under surveillance may sit in a different group than they did, which is a reason to review the pathway rather than to apply the new version only to new diagnoses.
The BCG maintenance statements matter particularly where supply is constrained, which has been the position in much of the world for several years. Guidance on who most needs maintenance is, in practice, guidance on how to ration it.
- Re-check patients already on surveillance against the revised risk stratification, not just new diagnoses
- Read the BCG maintenance statements against your actual supply position
- Subtype histology now has its own statements — make sure your pathology reporting captures it
- Enhanced cystoscopy recommendations affect equipment decisions, not just technique
- Thirty-eight studies formed the evidence base; the strength of each statement varies and is stated
Why it matters
Risk stratification is what drives surveillance interval, intravesical therapy and the cystectomy conversation, and it has changed.
Don't overread it
A guideline update synthesises existing evidence; the individual recommendations carry their own strength ratings and not all are strong.
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