The French journal of urology · 2026
Guidelines of the Oncology Committee of the French Association of Urology (CCAFU) and the Infectious Diseases Committee of the French Association of Urology (CIAFU) for Intravesical Instillation of Mitomycin C, Epirubicin, and BCG in NMIBC.
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Leon Priscilla, Long Depaquit Thibaut, Audenet François, Allory Yves, Masson-Lecomte Alexandra, Pradère Benjamin, Seisen Thomas, Xylinas Evanguelos, Gautier Marcq, Thibault Constance, Bajeot Anne Sophie, Prost Doriane, Rouprêt Morgan, Neuzillet Yann, Vallée Maxime, Roumiguié Mathieu
Аннотация
INTRODUCTION: Intravesical instillations of mitomycin C, epirubicin, and BCG are considered as the standard of care for most patients with non-muscle invasive bladder cancer (NMIBC). These guidelines aim to optimize intravesical instillations in order to improve their efficacy and decrease morbidity.
MATERIAL: An analysis of good practice, available regulations, and published guidelines was conducted through an online literature search in French and English using Medline® and Embase®, up to December 2025. The following keywords were used: "BCG"; "Mitomycin C"; "Epirubicin"; "Bladder"; "Complication"; "Toxicity"; "Adverse reaction"; "Prevention"; "Treatment".
RESULTS: Information should be given to the patient by the attending physician before the first intravesical instillation. A medical examination to detect specific contraindications is also mandatory to select appropriate therapy. Intravesical instillations should be delivered in health-care centers where urological endoscopic procedures are performed routinely. Screening for or treating asymptomatic bacteriuria prior to intravesical chemotherapy or BCG instillation is not recommended. In the presence of a clinically apparent urinary tract infection, instillations should be postponed. Intravesical instillation can only be delivered after a bladder catheter has been inserted without any injury to the lower urinary tract. The pharmaceutical agent should be retained in the bladder for 2h. Finally, voiding within 6h after intravesical instillation should be done in the seated position and the patient should drink at least 2L of water per day for 2 days.
CONCLUSION: The delivery of intravesical instillations of mitomycin C, epirubicin and BCG should follow a standardized procedure for better efficacy and lower morbidity.
MATERIAL: An analysis of good practice, available regulations, and published guidelines was conducted through an online literature search in French and English using Medline® and Embase®, up to December 2025. The following keywords were used: "BCG"; "Mitomycin C"; "Epirubicin"; "Bladder"; "Complication"; "Toxicity"; "Adverse reaction"; "Prevention"; "Treatment".
RESULTS: Information should be given to the patient by the attending physician before the first intravesical instillation. A medical examination to detect specific contraindications is also mandatory to select appropriate therapy. Intravesical instillations should be delivered in health-care centers where urological endoscopic procedures are performed routinely. Screening for or treating asymptomatic bacteriuria prior to intravesical chemotherapy or BCG instillation is not recommended. In the presence of a clinically apparent urinary tract infection, instillations should be postponed. Intravesical instillation can only be delivered after a bladder catheter has been inserted without any injury to the lower urinary tract. The pharmaceutical agent should be retained in the bladder for 2h. Finally, voiding within 6h after intravesical instillation should be done in the seated position and the patient should drink at least 2L of water per day for 2 days.
CONCLUSION: The delivery of intravesical instillations of mitomycin C, epirubicin and BCG should follow a standardized procedure for better efficacy and lower morbidity.