Bladder Cancer · University Urology, PC · Knoxville, TN
Intravesical Therapy for Bladder Cancer
Preparation, expectations, and recovery information for all intravesical (bladder instillation) treatments offered at University Urology. Select your specific therapy below for details.
About Intravesical Therapy
What Is Intravesical Therapy?
Intravesical therapy delivers medication directly into the bladder through a catheter. Because the drug stays in the bladder rather than circulating throughout the body, it targets tumor cells directly while limiting systemic side effects. It is used primarily for non-muscle invasive bladder cancer (NMIBC) — cancer that has not grown into the bladder muscle wall.
Multiple intravesical agents are used depending on the type, grade, and risk category of your bladder cancer. Your urologist will recommend the most appropriate treatment based on your specific pathology and history.
What to expect at every instillation visit
For all intravesical therapies: arrive with a comfortably full or empty bladder as instructed for your specific agent. A nurse or provider will pass a small catheter into your bladder, instill the medication, and remove the catheter. You will then hold the medication in your bladder for the time specified. Most patients drive themselves and return to normal activity the same day.
Treatment Agents
Intravesical Therapy Options at University Urology
Click through the details for your prescribed therapy below. If you are unsure which applies to you, contact our office.
BCG is the standard intravesical immunotherapy for high-grade NMIBC and carcinoma in situ (CIS). It works by stimulating your immune system to attack and destroy bladder cancer cells. BCG is typically given as an induction course of 6 weekly instillations, followed by maintenance instillations over 1–3 years.
Common side effects: Urinary urgency, frequency, and burning — especially after the first few instillations. Low-grade fever is common and usually resolves within 48 hours. Contact our office if fever exceeds 101.5°F, or if you have chills, joint pain, or feel systemically ill.
Important: Tell your provider before your instillation if you have blood in your urine, a urinary tract infection, or any open wounds or recent bladder injury. BCG should not be instilled into a traumatized bladder.
Anktiva is an IL-15 receptor agonist used in combination with BCG for BCG-unresponsive high-grade NMIBC with CIS. It enhances the immune response alongside BCG by activating natural killer cells and T cells in the bladder lining. Anktiva is mixed with BCG immediately before instillation and given together as a single instillation.
Common side effects: Similar to BCG alone — urinary urgency, frequency, dysuria, hematuria. Fatigue and flu-like symptoms may occur. The immune activation from the combination may be more pronounced than BCG alone.
Gemcitabine is an intravesical chemotherapy agent used for NMIBC, often as an alternative to BCG or in BCG-unresponsive patients. It is well tolerated with fewer systemic effects than BCG and is commonly used for intermediate-risk NMIBC or in patients who cannot tolerate BCG.
Common side effects: Urinary irritation, urgency, and burning are common but generally mild. Skin irritation around the urethra can occur. Contact our office if you develop significant pain or difficulty urinating.
Sequential gemcitabine followed by docetaxel is a combination intravesical chemotherapy regimen used for BCG-unresponsive or BCG-relapsing NMIBC. The two agents work through different mechanisms and are instilled back-to-back during the same visit, with a brief void between them. This regimen has shown meaningful response rates in patients who have failed BCG.
Common side effects: Urinary irritation, frequency, and dysuria. May be more pronounced than single-agent therapy. Fatigue is occasionally reported. Contact our office if symptoms are severe or persist between instillations.
Adstiladrin is an FDA-approved intravesical gene therapy for BCG-unresponsive high-grade NMIBC with CIS. It delivers a modified adenovirus carrying the interferon alfa-2b gene directly into bladder cells, causing them to produce interferon and stimulate a local anti-tumor immune response. It is given as a single instillation once every 3 months.
Important biosafety note: Adstiladrin contains a live modified adenovirus. For 24 hours after instillation, you must follow specific waste handling instructions provided at your visit. Caregivers and household members should avoid contact with your urine during this window. Do not share a toilet without flushing between uses.
Common side effects: Urinary discharge, urgency, frequency, and dysuria. Fatigue and flu-like symptoms may occur in the 24–48 hours following instillation.
Zusduri is a sustained-release hydrogel formulation of mitomycin, FDA-approved in June 2025 as the first medication specifically approved for adults with recurrent low-grade intermediate-risk NMIBC (LG-IR-NMIBC). Unlike standard mitomycin, Zusduri uses a proprietary RTGel technology that allows the drug to remain in contact with bladder tissue longer, enabling chemoablation of tumors without surgery. It is given as 6 once-weekly instillations.
Common side effects: Dysuria, urinary tract infection, hematuria, urinary urgency. Lab abnormalities (creatinine, potassium, liver enzymes) may occur — periodic lab monitoring may be ordered. Urinary retention and urethral stenosis have been reported in a small percentage of patients.
Do not receive Zusduri if you have a bladder perforation or known allergy to mitomycin. Inform your provider of all medications and supplements before starting treatment.
General Preparation
What to Expect at Every Visit
Before your instillation
Follow the fluid and bladder-fullness instructions specific to your therapy (listed above). Bring your medication list to every visit. Tell your nurse if you have any new urinary symptoms, fever, or feel unwell — instillation may need to be delayed if you have an active UTI or signs of bladder trauma.
During the procedure
A small urinary catheter is passed gently into your bladder. The medication is instilled over a few minutes. The catheter is removed. You will be asked to hold the medication for the prescribed time period, repositioning as instructed to distribute the drug evenly.
After you void
Follow the waste disposal instructions specific to your agent. BCG and Adstiladrin require specific precautions. Gemcitabine and Zusduri do not require special disposal but standard handwashing applies. If you experience severe burning, inability to urinate, or fever over 101.5°F, contact our office or go to the ER.
Between instillations
Some urinary irritation between treatments is normal. Drink plenty of water. Avoid caffeine and alcohol if irritation is significant. Do not skip instillations without speaking with your provider — adherence to the schedule is important for treatment effectiveness.
Surveillance cystoscopy
Intravesical therapy is paired with regular surveillance cystoscopy to monitor your bladder for recurrence or progression. Your urologist will outline your surveillance schedule. Results are typically discussed at your follow-up visit — see our results and follow-up page for timeframes.
When to call or go to the ER
Contact our office at (865) 305-9254 or go to the nearest emergency room if you experience: fever over 101.5°F after an instillation · inability to urinate · severe pain or worsening symptoms · signs of sepsis (chills, confusion, rapid heart rate) · significant or worsening blood in the urine. After hours, call our main number and follow prompts for the on-call provider.
Your Care Team
Bladder Cancer Specialists at University Urology
Intravesical therapy at University Urology is overseen by our fellowship-trained urologic oncologists and performed by our clinical team. Your specific regimen is determined by your urologist based on your pathology, prior treatment history, and NCCN risk classification.
Questions About Your Bladder Cancer Treatment?
Contact our office or message us through Klara. For urgent concerns after an instillation, call us immediately.