2026 Updates to the Diagnosis and Treatment of Non-muscle Invasive Bladder Cancer: AUA/SUO Guideline

The survival rate for the majority of patients with non-muscle invasive bladder cancer (NMIBC) is favorable; however, the rates of recurrence and progression to muscle-invasive bladder cancer are important surrogate endpoints for overall prognosis, as these are major determinants of long-term outcome. The recurrence and progression probability rates depend on several clinical and pathologic factors. Therefore, the ability to predict risk of recurrence and progression and treating the disease appropriately is important. This Guideline provides a risk-stratified clinical framework for the management of NMIBC.

During the 2025 update, a modified version of the Guideline search strategy was used to conduct a systematic search of Ovid MEDLINE and Embase for new evidence published between May 2023 and December 2025. The modified search added keywords for newly added therapeutic agents in accordance with the updated populations, interventions, comparators, and outcomes. The systematic search identified 2933 studies, of which 71 studies met inclusion criteria following title and abstract screening. Full-text review resulted in 38 studies being included in the final evidence base.

Updates were made to NMIBC risk stratification and statements on biomarkers, subtype histologies, transurethral resection, intravesical therapy, Bacillus Calmette-Guérin maintenance, enhanced cystoscopy, and future directions. Revisions were made to the methodology and reference sections as appropriate.

The Guideline updates herein seek to improve clinicians' ability to evaluate and treat patients with NMIBC based on currently available evidence. Future studies will be essential to further support or refine these statements to improve patient care.