Intravesical chemotherapy involves a healthcare professional injecting chemotherapy medication directly into the bladder to treat cancerous tumors.

“Intravesical” means “within the bladder.” Intravesical chemotherapy refers to chemotherapy treatment a healthcare professional applies directly into a person’s bladder to treat bladder cancer.

It is one of two types of intravesical therapy, the other being immunotherapy.

This article discusses intravesical chemotherapy for the treatment of bladder cancer.

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Intravesical chemotherapy is a therapeutic intervention that involves injecting chemotherapy medication directly into the bladder.

A healthcare professional uses a soft, flexible catheter to insert the medication, which then stays in the bladder for up to 2 hours.

The drugs cause the bladder lining to separate from the tissue layers underneath. The lining then passes out of the bladder through urine. The bladder can then grow a new lining that does not contain cancer cells.

This method also allows the drugs to reach the cells in the bladder lining without affecting other parts of the body.

Evidence suggests that intravesical chemotherapy following transurethral resection of bladder tumor (TURBT) can help prevent bladder cancer recurrence.

Healthcare professionals typically carry it out within 24 hours of TURBT, although some doctors suggest it should be done within 6 hours of the procedure. Intravesical chemotherapy aims to kill any remaining cancer cells in the bladder.

Doctors may also recommend intravesical chemotherapy to treat noninvasive, or stage 0, and minimally invasive, or stage 1, bladder cancers when intravesical immunotherapy does not work. These cancers are localized to the bladder lining and have not spread into the deeper layers of the bladder wall or elsewhere in the body.

People with low grade bladder cancer may only need one treatment with intravesical chemotherapy following TURBT.

Also, doctors may recommend one dose of intravesical chemotherapy within 24 hours of TURBT to treat more advanced cancers in stages 2–4. These later stage cancers have spread beyond the bladder wall and usually require additional treatments.

There are three chemotherapy drugs doctors use to treat bladder cancer:

  • Mitomycin: This is the most common drug. Doctors sometimes prescribe it alongside simultaneous heating of the bladder, known as electromotive mitomycin therapy.
  • Gemcitabine: This is less likely to become absorbed in the blood and may cause fewer side effects.
  • Valrubicin: Doctors may prescribe this drug if immunotherapy medication proves ineffective.

Learn about common chemotherapy drugs here.

For treatment to work best, a person should have as little urine in their bladder as possible. It is also best if the bladder does not fill with urine while the medications are inside.

A person should avoid drinking anything for 4 hours before their treatment. They should also avoid eating or drinking any products containing caffeine, such as:

If a person typically takes a diuretic, or water pill, they should avoid taking it until after treatment.

Intravesical chemotherapy is generally an outpatient procedure, but people may also have it after surgery. A person should follow a doctor’s recommendations for preparing for the procedure.

Before the procedure, a person will need to empty their bladder.

A healthcare professional will insert a sterilized catheter into the urethra, the small tube that connects the bladder to the outside of the body where a person expels urine. They will then inject medications into the catheter to flow directly into the bladder.

Sometimes, a male may get an involuntary reflex erection while the healthcare professional handles their penis. This is normal and will not affect their care. Taking deep breaths or thinking of something else may help it go away.

The catheter usually stays in place for 1–2 hours. The doctor may ask the person to stay in the facility for the duration of the treatment, or they may send them home with the medication still in the bladder.

After an agreed time, the person can urinate to void their bladder of the medication. They may need to take special steps to clean their skin and clean out the toilet following the release of urine for up to 6 hours after each treatment.

One should ask the doctor about the procedure they should follow after the appointment.

A person should follow all recommendations and instructions from the healthcare team after the procedure.

In most cases, a healthcare professional will instruct a person to drink more fluids than usual for 48 hours following the procedure. For example, they may need to drink an 8-ounce cup of water 8 times per day.

A person should also avoid beverages containing caffeine or alcohol during recovery.

Otherwise, an individual can typically resume their usual activities immediately after the procedure.

Side effects of intravesical chemotherapy are generally mild and often go away within a few days following treatment.

Potential side effects include:

  • a need to urinate more frequently
  • a burning sensation when urinating
  • a small amount of red or pink color in urine
  • the presence of small scabs or tissue from bladder lining

Most side effects are due to inflammation of the bladder lining, which health experts call cystitis. Drinking 2–3 liters of water per day can help with the side effects. Mild pain relief medication can also help.

A person should ask the doctor about what they can expect following the procedure. They should also contact the doctor if side effects do not improve within 48 hours.

The results of intravesical chemotherapy can vary based on the person’s overall health.

The 5-year relative survival rate for people with localized bladder cancer is 70%. This means that people with localized bladder cancer are about 70% as likely to be alive in 5 years as people in the general population.

A person should speak with a doctor about their likely survival rate based on their situation.

The following are answers to frequently asked questions about intravesical chemotherapy.

How soon can I have sex after intravesical chemotherapy?

According to a 2018 study, noninvasive bladder cancer can have a negative impact on a person’s sexual health and overall quality of life.

While treatment can help with cancer, a person should take precautions for up to 48 hours following the therapy by wearing a condom or having their partner wear a condom.

Also, a person should use some form of birth control to prevent pregnancy during treatment, as the drugs could harm an unborn baby.

A person should seek guidance from a doctor if they have questions about sex following intravesical chemotherapy.

Is intravesical chemotherapy painful?

Having a catheter inserted into the urethra and bladder may not be comfortable, and some people may find it painful.

Also, some side effects, such as a burning sensation when urinating, may be painful.

Intravesical chemotherapy can provide effective treatment for early stage bladder cancer either on its own or as part of other treatments.

The treatment involves injecting medication directly into the bladder as an independent treatment or following surgical procedures to treat bladder cancer. The procedure, which a person can undergo in an outpatient setting, generally involves minimal risk and side effects.

Following surgery, intravesical chemotherapy can help reduce the recurrence of the cancer.

Also, by having the medication injected directly into the bladder, a person may avoid many of the side effects of chemotherapy.