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Transurethral resection (TUR) with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy
Source: Bladder Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 2, 2025 · Captured 2026-09-09.
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Context: Treatment of Stage 0 Bladder Cancer / Treatment Options for Stage 0 Bladder Cancer
TUR and fulguration are the most common and conservative forms of management. Careful surveillance of subsequent bladder tumor progression is important. Because most bladder cancers recur after TUR, one immediate intravesical instillation of chemotherapy is often given after TUR. Numerous randomized controlled trials have evaluated this practice, and a meta-analysis of seven trials reported that a single intravesical treatment with chemotherapy reduced the odds of recurrence by 39% (odds ratio [OR], 0.61; P < .0001).[7,8] However, although a single instillation of chemotherapy lowers the relapse rate in patients with multiple tumors, most still relapse. Such treatment is insufficient by itself for these patients.
One retrospective series addressed the value of performing a second TUR within 2 to 6 weeks of the first TUR.[9][Level of evidence C3] A second TUR performed on 38 patients with Tis or Ta disease revealed that nine patients (24%) had lamina propria invasion (T1) and three patients (8%) had muscle invasion (T2).[9]
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Such information may change the definitive management options in these individuals. Patients with extensive multifocal recurrent disease and/or other unfavorable prognostic features require more aggressive forms of treatment.
Evidence (TUR with fulguration followed by immediate postoperative instillation of intravesical chemotherapy):
A 2004 meta-analysis of seven randomized controlled trials (1,476 patients with stage Ta or stage T1 bladder cancer) compared TUR alone with TUR followed by a single immediate intravesical instillation of chemotherapy.[7]
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A 2004 meta-analysis of seven randomized controlled trials (1,476 patients with stage Ta or stage T1 bladder cancer) compared TUR alone with TUR followed by a single immediate intravesical instillation of chemotherapy.[7]
The relapse rate was 48% for patients who received TUR alone and 37% for patients who received TUR plus intravesical chemotherapy (OR, 0.61; P < .0001). The risk of recurrence declined for patients with single (OR, 0.61) or multiple (OR, 0.44) tumors, but 65% of those with multiple tumors relapsed despite intravesical chemotherapy.
A 2004 meta-analysis of seven randomized controlled trials (1,476 patients with stage Ta or stage T1 bladder cancer) compared TUR alone with TUR followed by a single immediate intravesical instillation of chemotherapy.[7]
Agents studied included epirubicin, mitomycin (MMC), thiotepa, and pirarubicin.
A subsequent multicenter randomized controlled trial confirmed the reduction in risk of recurrence. A study that included 404 patients reported a relapse rate of 51% for patients who received epirubicin immediately after TUR and 63% for patients who received placebo immediately after TUR (P = .04). However, only small recurrences were prevented in this study, drawing into question the magnitude of benefit.[10]
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Similarly, another multicenter randomized controlled trial confirmed the reduction in risk of recurrence. One study randomly assigned patients (N = 305) to receive either an instillation of epirubicin or no further treatment after TUR.[8]
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Similarly, another multicenter randomized controlled trial confirmed the reduction in risk of recurrence. One study randomly assigned patients (N = 305) to receive either an instillation of epirubicin or no further treatment after TUR.[8]
The relapse rates were 62% for patients who received epirubicin and 77% for patients in the control arm (P = .016).
Similarly, another multicenter randomized controlled trial confirmed the reduction in risk of recurrence. One study randomly assigned patients (N = 305) to receive either an instillation of epirubicin or no further treatment after TUR.[8]
The hazard ratio for recurrence was 0.56 (P = .002) with epirubicin. However, the main benefit was seen in patients at lower risk of relapse. Among patients at intermediate or high risk of relapse, the relapse rates were 81% with epirubicin versus 85% with no further treatment (P = .35).
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Preserved source evidence · Not medical advice