An early single instillation of intravesical chemotherapy (SICI) used immediately after transurethral resection of the bladder (TURB) can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer (NMIBC). SICI should be used in patients with low-risk and with selected intermediate-risk tumours, in particular for multiple primary small papillary tumours, single primary papillary tumours >3cm, and single recurrent papillary tumours recurring >1yr after the previous resection. The available data do not support any recommendation to reduce the role of SICI in patients after fluorescence cystoscopy-guided TURB or en bloc TURB. SICI can even provide some benefit in patients with intermediate-risk tumours subsequently treated with further instillations. During instillation, contraindications should be taken into account and safety measures should be applied. PATIENT SUMMARY: An early single instillation of intravesical chemotherapy immediately after transurethral resection of the bladder can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer. It should be used in patients with low-risk and selected intermediate-risk tumours.

Department of Pathology Hôpital Tenon AP HP Sorbonne University Paris France

Department of Surgery and Cancer Imperial College London London UK; Department of Urology Lister Hospital East and North Hertfordshire NHS Trust Stevenage UK

Department of Urology Caritas St Josef Medical Centre University of Regensburg Regensburg Germany

Department of Urology Fundació Puigvert Universidad Autónoma de Barcelona Barcelona Spain

Department of Urology General University Hospital 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Hôpital La Pitié Salpétrière AP HP Sorbonne University Paris France

Department of Urology Hospital Motol 2nd Faculty of Medicine Charles University Praha Czech Republic; Medical University of Vienna Vienna General Hospital Vienna Austria

Department of Urology Hospital Motol 2nd Faculty of Medicine Charles University Praha Czech Republic; Medical University of Vienna Vienna General Hospital Vienna Austria; Department of Urology University of Texas Southwestern Medical Center Dallas TX USA; Department of Urology Weill Cornell Medical College New York NY USA

Department of Urology Hospital Universitario Fundación Alcorcón Madrid Spain

Department of Urology Medical University of Graz Graz Austria

Department of Urology Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Royal Surrey County Hospital Guildford UK

Department of Urology San Giovanni Battista Hospital Città della Salute e della Scienza University of Turin Turin Italy

European Association of Urology Guidelines Office Brussels Belgium

Service d'Urologie CHU de Rennes Rennes France

Servicio de Urología Fundación Instituto Valenciano de Oncología Valencia Spain

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Recurrence mechanisms of non-muscle-invasive bladder cancer - a clinical perspective