ABSTRACT

Treatment and follow-up of non-muscle invasive bladder cancer (NMIBC) is the most difficult and most expensive one in whole urologic cancers. NMIBC is in the form of a heterogeneous disease that includes sub-types such as CIS and Ta-T1 tumors. Cystectomy, the final treatment in patients with frequently recurring NMIBC is the treatment method increasing the patients' morbidity and mortality. Various intravesical therapy modalities were so far applied to, and are still being tried to develop for the patients without a muscle invasive disease that does not require cystectomy, or for the patients who refuse or can not tolerate cystectomy. BCG is the oldest of these treatment modelities and BCG maintenance therapy that can take up to 3 years are now taken its place in guidelines. However, there are problems of this treatment such as irresponsive patients to therapy and a number of side effects. For this reason, many therapy modalities have been tested alternative to BCG, but none of them was as successful as BCG alone. So the researchers have tried to develop many new techniques for improving the efficacy and reducing the side effects of BCG and other intravesical therapies. Even though mechanism of action was well understood for some of these methods, many of the others are still at an experimental stage.