The UroOnc Minute: Perioperative Intravesical Chemotherapy at Nephroureterectomy, With Surena F. Matin, MD, FACS

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, speaks with Surena F. Matin, MD, FACS, professor of urology at MD Anderson Cancer Center, about the evolving role of intravesical chemotherapy for preventing bladder cancer recurrence after nephroureterectomy.

Matin reviews the evidence supporting single-dose chemotherapy following surgery, including randomized studies evaluating mitomycin and pirarubicin, and discusses how these data established intravesical treatment as an important strategy for reducing the risk of subsequent bladder recurrence. He also highlights the favorable safety profile observed across these studies, noting that the potential benefit must be considered alongside the relatively low risk associated with a single perioperative instillation.

The conversation then turns to how clinical practice has evolved, including the shift toward gemcitabine and the growing interest in administering chemotherapy intraoperatively rather than waiting until after surgery. Matin describes his approach to intraoperative instillation, including the timing of treatment, ureteral management, minimizing bladder distention and chemotherapy dilution, and maintaining a closed system to improve safety and efficiency. He also explains how this workflow can allow patients to have their catheter removed before discharge, potentially avoiding the logistical challenges associated with delayed postoperative instillation and additional follow-up procedures.

Weiner and Matin also discuss the recently published phase 3 JCOG1403 study, which further supports the use of perioperative intravesical chemotherapy,¹ as well as the remaining questions surrounding the optimal agent, timing, and patient selection. Although prospective data directly comparing intraoperative and delayed administration are still lacking, Matin notes that the intraoperative approach may offer important practical advantages for both patients and clinicians. The episode concludes with a discussion of barriers to implementing intravesical chemotherapy across different practice settings and the need for additional data to better define the benefit in specific patient subgroups, including those with low- vs high-grade disease.

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