What are the recommended follow-up protocols for patients diagnosed with non-muscle invasive bladder cancer?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

The recommended follow-up protocols for patients diagnosed with non-muscle invasive bladder cancer (NMIBC) vary depending on the risk classification of the cancer .

  • Low-risk non-muscle-invasive bladder cancer: Patients should be offered cystoscopic follow-up at 3 months and 12 months after diagnosis . Urinary biomarkers or cytology should not be used in addition to cystoscopy for follow-up in these cases . Patients who have had low-risk NMIBC and no recurrence within 12 months can be discharged to primary care . Routine urinary cytology or prolonged cystoscopic follow-up beyond 12 months is not recommended for these patients .
  • Intermediate-risk non-muscle-invasive bladder cancer: Cystoscopic follow-up should be offered at 3, 9, and 18 months, and then once a year thereafter . Discharge to primary care can be considered after 5 years of disease-free follow-up .
  • High-risk non-muscle-invasive bladder cancer: Cystoscopic follow-up is recommended every 3 months for the first 2 years . This is followed by every 6 months for the next 2 years, and then once a year thereafter .

Regardless of risk category, people with a history of non-muscle-invasive bladder cancer who experience haematuria or other urinary symptoms should be referred urgently to urological services .

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