Words of Wisdom RE: Low adherence to guidelines in nonmuscle-invasive disease

The authors address the thorny issue of the lack of adherence to Clinical Practice Guidelines highlighting high-quality evidence based nonmuscle-invasive bladder cancer (NMIBC) guideline recommendations from the American Urological Association/Society of Urologic Oncology, and the European Association of Urology as exemplars [1]. In particular, they emphasise three strong practice recommendations underpinned by high-quality evidence: immediate intravesical installation of chemotherapy in patients with presumed low-risk or intermediate-risk NMIBC, the performance of a second transurethral resection for high-risk NMIBC, and the administration of adjuvant intravesical Bacillus Calmette–Guérin immunotherapy in high-risk NMIBC. Data from North America, Europe, and Australia are cited illustrating variability and general lack of adherence (ranging from 0.5% to 65%) to these recommendations.