Perioperative Intravesical Therapy

For well over a decade, the results of prospective, randomized, controlled clinical trials performed primarily outside the United States have shown that intravesical instillation of chemotherapeutic agents immediately after transurethral resection of bladder tumor (TURB) decreases the likelihood of tumor recurrence, particularly for patients with newly diagnosed bladder cancers. Despite this, guidelines by the American Urological Association do not advocate its use as standard of care for the treatment of superficial bladder cancer while the European Association of urology does. We have reviewed the world literature and feel that there is ample evidence to recommend the routine use of intravesical mitomycin C after transurethral resection of bladder tumors in the United States.Using a health-care based medical research database there is significant under-utilization of perioperative intravesical chemotherapy by American urologists. Reasons for this policy not being incorporated into standard practice, including barriers to its acceptance and performance, are unclear. Furthermore, an analysis for potential cost savings with its incorporation in routine care of patients with low-grade superficial bladder cancer revealed a $24.8 million cost savings to the American health care system per year. We therefore conclude that there is ample evidence to show that immediate intravesical chemotherapy can decrease the likelihood of tumor recurrence and adopting this policy would significantly lower the cost of care for bladder cancer in the U.S.