A 55-year-old male with recurrent urinary tract infections and haematuria undergoes flexible cystoscopy showing a 2 cm papillary bladder tumour. TURBT histology reveals high-grade Ta urothelial carcinoma with no lamina propria invasion. Adjuvant intravesical therapy of choice is:

• A Intravesical gemcitabine weekly for 6 weeks
• B Radical cystectomy
• C Intravesical mitomycin C single dose immediately post-TURBT only
• D Intravesical BCG induction for 6 weeks followed by maintenance ✓

Explanation

High-grade Ta (non-muscle-invasive) bladder cancer carries significant risk of recurrence (50–70%) and progression to muscle-invasive disease. Intravesical BCG induction (6 weekly instillations) followed by maintenance therapy (EAU guidelines recommend 1–3 year maintenance) is the gold standard for high-grade NMIBC. A single perioperative dose of mitomycin C is appropriate for low-risk tumours to prevent immediate implantation of shed cells.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.