1. Introduction
1.1 Aim and scope
The European Association of Urology Nurses (EAUN) was created in April 2000 to represent European urology nurses. The EAUN’s underlying goal is to foster the highest standards of urological nursing care throughout Europe, with the aim of directly helping our members develop or update their expertise.
The EAUN Guidelines Panel has prepared these Guidelines with the aim of increasing the quality of care for patients receiving intravesical instillations of mitomycin C or Bacillus Calmette-Guérin (BCG) in non-muscle invasive bladder cancer (NMIBC). The Guidelines are intended to support nurses and practitioners who are already competent in the procedure of intravesical instillations. Importantly, the Guidelines also highlight the psychological and social aspects unique to patients undergoing intravesical instillations, with a focus on quality of life (QoL). The Guidelines should be applied within the context of local policies and existing protocols.
The Guidelines provide clear illustrations and annotated procedures to help nurses identify potential problem areas and safely carry out effective patient care and address the following points:
- indications and contraindications
- safety precautions
- nursing interventions
- interventions in intravesical instillations
- aspects of patient education and patient perspectives
It must be emphasised that, although clinical guidelines present the best evidence available to the experts, following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients but rather help to focus decisions
- including considering the personal values and preferences/individual circumstances of patients and their caregivers. The Guidelines are not mandates and do not purport to be a legal standard of care.
1.1.1 Role of the nurse in different countries
EAUN is a professional organisation of European nurses who specialise in urological care. The level of education and practical training of nurses in urology varies widely throughout Europe, with the roles and responsibilities of nurses differing among countries. This makes it difficult for any guideline to fulfil all requirements or expectations of individual practitioners. The EAUN, however, aims to ensure that
every nurse and healthcare professional will benefits from using these guidelines. Job titles often differ within the specialty in different countries, and even in different areas within the same country. Therefore, in this document, the term ‘nurses’ is understood to refer to all nurses working with intravesical instillation as specialised nurses.
1.2 Panel composition
The EAUN Guidelines Panel on Intravesical Instillation with Mitomycin C or BCG in NMIBC consists of an international group of nurse practitioners and clinicians with particular expertise in this area. All the experts involved in the production of this document have submitted a potential conflict of interest (COI) disclosure form, all of which are available upon request.
1.3 Publication history
The EAUN Guidelines on Intravesical Instillations were first published in 2015. This 2026 publication has been updated throughout and developed using an updated methodology as detailed in the Methodology chapter. An open access version of the text and a downloadable PDF are available on the EAUN website: www.eaun.org/ guidelines.
1.4 Summary of changes
For the 2026 guidelines update new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the guidelines. The guidelines text has been carefully reviewed and updated accordingly. The recommendations have been reviewed in full and reworked to aid practical implementation. Specific changes include:
- 5.1 Contraindications for intravesical instillations - The categorisation of UTI as localised UTI (e.g. “cystitis”) or systemic UTI according to the 2025 EAU Guidelines of Urological Infections: www.uroweb.org/guidelines/urological-infections.
- 10.1 Patient assessment - Prior to both initial and subsequent administrations of intravesical therapy, patients must be assessed before and after each instillation, focusing on overall health status and symptoms indicative of UTI. Dip-stick testing alone is not recommended for ruling out UTI. Clinical evaluation is essential to avoid unnecessary antibiotic use, thereby supporting antibiotic stewardship and reducing the risk of antimicrobial resistance.
- 10.2 Pre-procedure nutrition - Consistent evidence has established the critical role of nutrition as the fourth pillar in cancer care. Despite evidence showing that integrating adequate nutritional care into standard cancer care, positively impacts relevant clinical outcomes; health related quality of life (HRQoL) and reduction of toxicities or complications, there remain limited studies of the impact of nutrition in NMIBC.
- 12 Patient Quality of Life - There is an emerging understanding of the impact on HRQoL on NMIBC cancer treatment. Systematic reviews have found that NMIBC patients have a substantial symptom and functional burden that impacts HRQoL throughout the induction period of treatment but returns to baseline level by the end of the maintenance period of treatment. New longitudinal data also document that HRQoL is comparable with that of the general population after four years.
- 13 Patient experience - Patient experience is added to this update acknowledging that patient experience and preferences are important to facilitate adherence to treatment.