Implementation challenges of single-instillation intravesical chemotherapy following transurethral resection of bladder tumor.

Abstract

Introduction: Despite strong evidence supporting its effectiveness, single, immediate instillation of intravesical chemotherapy (SI-IVC) following transurethral resection of bladder tumor (TURBT) remains vastly underutilized in managing low- and intermediate-risk non - non-muscle-invasive bladder cancer (NMIBC). This review addresses the gap between evidence and practice in adopting this cost-effective, recurrence-reducing intervention and offers potential solutions through an implementation science approach.

Areas covered: We examined the clinical benefits of SI-IVC based on landmark trials and meta-analyses across various agents, including mitomycin and gemcitabine. A targeted literature review was conducted using PubMed and major urology guidelines to identify studies assessing efficacy, utilization rates, and barriers to implementation. Particular focus is given to logistical and systems-based challenges limiting real-world application, including issues with drug availability, perioperative workflow, and post-resection coordination. We also discuss strategies informed by an implementation science framework, including planning and system engagement, executing interventions, and evaluating their impact within hospital systems.

Expert opinion: Incorporating SI-IVC into routine practice requires pragmatic, system-level changes that address logistical barriers rather than clinical hesitancy. With institutional support and streamlined protocols, SI-IVC can be more consistently delivered, however, local adaptation and fine-tuning remain essential, as healthcare systems and available personnel vary across institutions.