Muscle-invasive and Metastatic Bladder Cancer

2. METHODS

2.1. Data identification

For the 2025 MIBC Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the MIBC Guideline was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between the 1^st of May 2023 and 1^st May 2024. A total of 1,102 unique records were identified, retrieved and screened for relevance. A detailed search strategy is available online: https://uroweb.org/guidelines/muscle-invasive-and-metastatic-bladder-cancer/publications-appendices.

Recommendations within the Guidelines are developed by the panels to prioritise clinically important care decisions. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and the nature and variability of patient values and preferences. This decision process, which can be reviewed in the strength rating forms which accompany each guideline statement, addresses a number of key elements:

1. the overall quality of the evidence which exists for the recommendation [5];
2. the magnitude of the effect (individual or combined effects);
3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
4. the balance between desirable and undesirable outcomes;
5. the impact and certainty of patient values and preferences on the intervention.

Strong recommendations typically indicate a high degree of evidence quality and/or a favourable balance of benefit to harm and patient preference. Weak recommendations typically indicate availability of lower quality evidence, and/or equivocal balance between benefit and harm, and uncertainty or variability of patient preference [6].

Additional methodology information and a list of associations endorsing the EAU Guidelines can be found in the online: https://uroweb.org/eau-guidelines/methodology-policies.

2.2. Peer-review

The panel intends to submit the 2026 MIBC guidelines for peer review before publication. All systmetic reviews and summary papers derivied from the guidelines have been peer reviewed prior to publication.

2.3. Future goals

Topics considered for inclusion in the 2026 update of the MIBC Guidelines:

• Development of a consensus-based strategy for functional- and oncological follow-up of patients treated for MIBC;
• Participation in developing strategies to ensure meaningful participation of patients in the development and implementation of the MIBC Guidelines.