title: EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013.
abstract: BACKGROUND
  The first European Association of Urology (EAU) guidelines on bladder cancer were published in 2002 [1]. Since then, the guidelines have been continuously updated.
  
  
  OBJECTIVE
  To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation were assigned.
  
  
  RESULTS
  Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/.
  
  
  CONCLUSIONS
  These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
  
  
  RESULTS
  The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo- or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo- or immunotherapy, or who are in the highest risk group for progression.
authors.affiliation: Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic. marek.babjuk@lfmotol.cuni.cz
authors.forename: Marko
authors.initials: M
authors.lastname: Babjuk
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Bas W G
authors.initials: BW
authors.lastname: van Rhijn
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Sylvester
authors.forename: Eero
authors.initials: E
authors.lastname: Kaasinen
authors.forename: Andreas
authors.initials: A
authors.lastname: Böhle
authors.forename: Joan
authors.initials: J
authors.lastname: Palou Redorta
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001500:BCG Vaccine / Q000008:administration & dosage; D001706:Biopsy / Q000592:standards; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000592:standards*; D003558:Cystoscopy / Q000592:standards; D003950:Diagnostic Techniques, Urological / Q000592:standards*; D018450:Disease Progression; D005060:Europe; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012955:Societies, Medical / Q000592:standards*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D014572:Urology / Q000592:standards*; D019459:Urothelium / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D001500:BCG Vaccine
keywords: Bacillus Calmette-Guerin (BCG); Bladder cancer; Cystectomy; Cystoscopy; Diagnosis; EAU Guidelines; Follow-up; Intravesical chemotherapy; Prognosis; Transurethral resection (TUR); Urothelial carcinoma