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Objectives: Clinical guidelines recommend that patients with non‐muscle‐invasive bladder cancer (NMIBC) should be treated with appropriate adjuvant therapy. However, compliance with guideline recommendations is insufficient, and this may lead to unfavorable outcomes. We aimed to investigate the level of adherence to guideline recommendations in patients with NMIBC and evaluate the outcomes of those who did and did not receive guideline‐recommended therapies. Methods: We performed a retrospective analysis of patients with histologically diagnosed NMIBC. The percentage of patients with intermediate‐ and high‐risk tumors who received adjuvant intravesical therapy or second transurethral resection (TUR) was calculated. Recurrence‐free survival was assessed in patients who did and did not receive the therapies. We conducted a propensity score‐matched analysis to compare outcomes between patients with intermediate‐risk and T1 NMIBC who did and did not undergo guideline‐recommended therapies. Results: Overall, 1204 patients from the Tohoku Urological Evidence‐Based Medicine Study Group and Kyoto University Hospital were included. Of patients with intermediate‐ and high‐risk tumors, 91.0% and 74.0% did not receive maintenance bacillus Calmette–Guérin (BCG), respectively. In both groups, significantly better recurrence‐free survival was found for patients treated with maintenance BCG. Among patients with T1 NMIBC, only 16.7% underwent guideline‐recommended therapies, that is, a second TUR and maintenance BCG. Significantly greater recurrence‐free survival was observed in patients who received guideline‐recommended therapies compared with propensity‐matched patients who did not. Conclusions: Guideline‐recommended therapies may contribute to improvements in outcomes for patients with NMIBC, suggesting that improvements in adherence to clinical guidelines may lead to favorable outcomes. [ABSTRACT FROM AUTHOR]