Bladder Cancer Clinical Practice Guidelines (EAU, 2021)

European Association of Urology (EAU)

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

October 01, 2021

Clinical practice guidelines on non–muscle-invasive bladder cancer by the European Association of Urology (EAU) were published in September 2021 in European Urology.[1]


For the initial evaluation in patients who present with hematuria, renal and bladder ultrasonography and/or computed tomography (CT) intravenous urography are recommended. CT urography is recommended for patients who have tumors in the trigone or who have high-risk or multiple tumors.

Perform cystoscopy in patients whose symptoms suggest bladder cancer. To detect high-grade tumors, use voided urine cytology as an adjunct to cystoscopy.

Transurethral resection of the bladder (TURB) followed by histopathologic examination of the specimen is recommended. If the results of the first resection are incomplete, no muscle is obtained in the specimen, or a T1 tumor is found, another TURB should be performed 2-6 weeks after the initial procedure.

Assess the patient’s risk of disease progression with the 2021 EAU scoring model. Determine whether the patient is at low, intermediate, high, or very high risk.


In patients with low-risk tumors and in those who have small papillary recurrences that are found more than 1 year after a previous TURB, one immediate instillation of chemotherapy is recommended.

For patients who have intermediate-risk tumors, the recommended treatments are either 1 year of full-dose intravesical bacillus Calmette-Guérin (BCG) immunotherapy or instillations of chemotherapy for up to 1 year.

For patients who have high-risk tumors, full-dose intravesical BCG immunotherapy for 1-3 years is recommended.

Consider immediate radical cystectomy for patients with very high-risk tumors. Cystectomy is also an option for patients who have tumors that fail to respond to BCG immunotherapy.

For more information, please go to Bladder Cancer.


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