ArticleBJU international2026
Adoption, consistency, and usability of NICE vs EAU guidelines in low- and intermediate-risk NMIBC: a cross-sectional survey of UK urologists.
Article in BJU international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate current adoption of guidelines for low- and intermediate-risk non-muscle-invasive bladder cancer (NMIBC) in the UK and to assess clinicians' ability to apply their chosen guideline consistently to real-world clinical scenarios. PATIENTS AND
methodsThis study is a cross-sectional survey distributed to clinicians involved in the management of NMIBC in the UK. Respondents reported their unit-level and personal guideline adoption (National Institute for Health and Care Excellence [NICE] vs European Association of Urology [EAU]) and completed three case-based real-life scenarios derived from NMIBC cases with discordant risk stratification between NICE and EAU guidelines. Cases were randomly selected from a local database using a computer-generated random number function in Microsoft Excel. Concordance between respondents' decisions and their stated guideline was assessed for risk stratification and surveillance duration.
resultsA total of 174 eligible responses were analysed. Most units (38%) followed NICE guidelines, but individual clinicians most frequently reported that they were following EAU guidelines (39%). Those who followed NICE guidelines demonstrated significantly higher compliance with the duration of follow-up as recommended in the guidelines than did those who followed EAU guidelines (78.9% vs 49.2%, P < 0.001). Deviations from the guidelines for those who followed NICE were predominantly in duration of surveillance, which was longer than recommended. Conversely, those following EAU guidelines frequently opted for shorter-than-recommended follow-up (P < 0.001). Consistent guideline-based risk stratification was achieved in 77.1% of those following NICE guidelines and 34.1% of those following EAU guidelines (P < 0.001). Acceptable recurrence risk at discharge did not differ between guideline groups (P = 0.278).
conclusionsSubstantial variation exists in NMIBC guideline adherence and real-world application in the UK. NICE guidance was associated with greater consistency and utility compared with EAU guidance for low- and intermediate-risk disease. These findings highlight the need for clearer, unified recommendations to promote equitable care and rational use of surveillance resources.
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