Intravesical instillations of mitomycin C, epirubicin, and BCG are considered as the standard of care for most patients with non-muscle invasive bladder cancer (NMIBC). These guidelines aim to optimize intravesical instillations in order to improve their efficacy and decrease morbidity.
An analysis of good practice, available regulations, and published guidelines was conducted through an online literature search in French and English using Medline® and Embase®, up to December 2025. The following keywords were used: "BCG"; "Mitomycin C"; "Epirubicin"; "Bladder"; "Complication"; "Toxicity"; "Adverse reaction"; "Prevention"; "Treatment".
Information should be given to the patient by the attending physician before the first intravesical instillation. A medical examination to detect specific contraindications is also mandatory to select appropriate therapy. Intravesical instillations should be delivered in health-care centers where urological endoscopic procedures are performed routinely. Screening for or treating asymptomatic bacteriuria prior to intravesical chemotherapy or BCG instillation is not recommended. In the presence of a clinically apparent urinary tract infection, instillations should be postponed. Intravesical instillation can only be delivered after a bladder catheter has been inserted without any injury to the lower urinary tract. The pharmaceutical agent should be retained in the bladder for 2 h. Finally, voiding within 6 h after intravesical instillation should be done in the seated position and the patient should drink at least 2 L of water per day for 2 days.
The delivery of intravesical instillations of mitomycin C, epirubicin and BCG should follow a standardized procedure for better efficacy and lower morbidity.
The French journal of urology. 2026 Jun 26 [Epub ahead of print]
Priscilla Leon, Thibaut Long Depaquit, François Audenet, Yves Allory, Alexandra Masson-Lecomte, Benjamin Pradère, Thomas Seisen, Evanguelos Xylinas, Marcq Gautier, Thibault Constance, Bajeot Anne Sophie, Prost Doriane, Morgan Roupret, Yann Neuzillet, Maxime Vallée, Mathieu Roumiguié
Service d'Urologie, Clinique Pasteur, Royan, France. Electronic address: ., Service d'Urologie, CHU de Marseille, France., Service d'Urologie, Hôpital Européen Georges Pompidou, Université Paris Cité, France., Service d'Anatomopathologie, Institut Curie, Université de Paris Saclay, Saint-Cloud, France., Service d'Urologie, Hôpital Saint-Louis, Université Paris Cité, France., Service d'Urologie, Clinique la Croix du Sud, Toulouse, France., Service d'Urologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France., Service d'Urologie, Hôpital Bichat, Université Paris Cité, Paris, France., Service d'Urologie, CHU de Lille, France., Service d'Oncologie Médicale, Hôpital Européen Georges Pompidou, Université Paris Cité, France., Service d'Urologie, CHU Institut Universitaire du Cancer de Toulouse, Toulouse, France., Service d'Urologie, Hôpital Foch, Université de Paris Saclay, Suresnes, France., Département d'Urologie et de Transplantation Rénale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; Université de Poitiers, Unité INSERM U1070, PHAR2, F-86000 Poitiers, France., Service d'Urologie, Clinique Pasteur, Toulouse, France.