Intravesical Salvage Therapy After BCG/Regular Chemo

High-risk, nonmuscle-invasive bladder remains one of the most expensive, recurrent, and frustrating diseases for the urologist in practice. BCG therapy is the mainstay of frontline therapy; however, recurrence will still occur for 40–80% of patients over a 10-year period. Radical cystectomy with urinary diversion remains the standard of care for many of these patients; however, recent evidence suggests that this is underutilized as many patients are either unfit for or unwilling to undergo such major extirpative therapy. Fortunately, there is a 6–24-month window of time after BCG to consider intravesical salvage therapy while not adversely affecting progression to muscle-invasive disease. In this chapter, practical guidance for the administration of several regimens including the expected side effects and cancer-specific outcomes is reviewed.