Several antitumor agents for the management of non-muscle invasive bladder cancer after TUR have been developed. Today, the most common used agents are doxorubicin (adriamycin), epirubicin, mitomycin-C, and BCG. Gemcitabine, Valrubicin or interferon are rarely used. Combination of these agents has no clear benefit.

It is considered that the interval after TUR should be 1–2 weeks in chemotherapy and 2–4 weeks in immunotherapy for tissue healing to avoid complications. A urinalysis should be performed before each intravesical treatment. The presence of infected urine may cause complications such as bacteremia and fever. The bladder should be emptied just before intravesical instillation, and patient should be advised to avoid excessive fluid intake on the day of instillation to prevent dilution of the agent in the bladder. After catheterization, if exists, residual urine should be emptied before the instillation. The diluted agent in 50 ml normal saline or distilled water is instilled to the bladder under low pressure with an injector through a low caliber catheter. We prefer 10 or 12 Ch feeding tube well lubricated with lidocaine jelly. Urethral trauma and bleeding during catheterization should be avoided and when it occurs, the instillation should be postponed for several days. Also, in patients with marked hematuria the instillation should not be done.

Preferably, the instilled agent should remain in the bladder for 1 h in chemotherapy and for 2 h in immunotherapy. The patient does not need to turn from side to side to bathe the entire urothelium. Coffee or tea consumption just before the instillation may interfere with retention tolerance of the agent for 1–2 h. For patients who cannot tolerate retention at least for 1 h, anticholinergics may be helpful. Then the patient is asked to empty his or her bladder. For patients with prostatic enlargement, there might be a marked residual urine, therefore voiding in sitting position or double voiding is recommended to empty the bladder completely. Patients should be informed not to contact the voided urine in the toilet and the contaminated surfaces should be well cleaned with bleach.