Guidelines adherence in non-muscle-invasive bladder cancer: a global survey of 3595 participants

To investigate the implementation and adherence of (inter)national guidelines (GLs) on non-muscle-invasive bladder cancer (NMIBC) across continents.

An international, inter-lingual survey was designed to capture the practice of diagnosis and treatment of NMIBC globally, including questions designed to evaluate compliance to GLs. An invitation was sent to members of the Société Internationale d'Urologie (SIU). We assessed the adherence to GLs in relation to age, working environment, subspecialities, gender, and years of experience.

A total of 3595 urologists took part in the survey and 2319 provided information about their compliance to European Association of Urology (EAU), American Urological Association (AUA), and other (inter)national GLs. The survey comprised 92% males including >50% in clinical practice for >15 years; 57% were in general practice, whereas 17% were qualified uro-oncologist and 8% endourologist. The majority were in academic practice and most (60%) performed <5 transurethral resection of bladder tumour/month. GLs were followed in 42-70% of cases when taking bladder biopsies. The majority followed the EAU GLs (40%) followed by national GLs modified from the AUA, EAU or similar GLs (31%), or national GLs by their own societies (14%). Low participation from the Americas may limit the applicability of findings to that region; future studies should engage more diverse North American samples to enhance generalisability.

The EAU GLs were mostly preferred in NMIBC diagnosis and treatment across all continents. General adherence to the GLs was inconsistent, with notable variances among the different regions. As GLs provide the best evidence-based knowledge, it is advised to adhere to them more consistently in daily clinical practice.