Objective:Information on bladder cancer (BC) according to the subtype of tumors in a general population is scarce despite its clinical relevance. The objective was to describe the characteristics of incident BC in a general population, with a focus on the initial management of high-risk non-muscle invasive BC (HR-NMIBC) given the unfavorable evolution these cases may take. Materials:BC incident in 2011-2012 registered in a population-based cancer registry were studied. Data was extracted from the medical files. NMIBC were classified according to potential risk for recurrence/progression. Individual and tumor characteristics of incident BC were described. Incidence, initial management and survival (12/31/2021) of HR-NMIBC were assessed. Results:Among 538 BC cases, 380 were NMIBC (119 low (22.1%), 163 intermediate (30.3%), 98 high (18.2%) risk) and 147 (27.3%) were MIBC. HR-NMIBC diagnostic and therapeutic management (imaging, re-TUR, multi-disciplinary team meetings (MDT) assessment, specific treatment) revealed discrepancies with guidelines recommendations. Seventy-two out of 98 cases were assessed during an MDT with a median time from diagnosis of 18 days [First quartile:12-third quartile:32]. Treatment agreed with MDT decisions globally. Intravesical instillation was the most common treatment (n=56) but 27 HR-NMIBC did not receive specific treatment after TUR. Five and 10 years overall survival was 52%[42-63] and 41%[31-51] respectively. Five years net survival was 63%[47-75]. Conclusions:Despite National cancer plans aiming at improving care giving and despite the severity of HR-NMIBC, guideline-recommended patterns of care were underused in this region. This may deserve attention to identify obstacles to guideline adoption to try to improve BC patient care and survival.