Implementation challenges of single-instillation intravesical chemotherapy following transurethral resection of bladder tumor

Despite strong evidence supporting its effectiveness, single,immediate instillation of intravesical chemotherapy (SI-IVC) following transurethralresection of bladder tumor (TURBT) remains vastly underutilized in managinglow- and intermediate-risk non - muscle-invasive bladder cancer (NMIBC). Thisreview addresses the gap between evidence and practice in adopting thiscost-effective, recurrence-reducing intervention and offers potential solutionsthrough an implementation science approach. We examine the clinical benefits of SI-IVC based on landmark trialsand meta-analyses across various agents, including mitomycin C and gemcitabine.A targeted literature review was conducted using PubMed and major urologyguidelines to identify studies assessing efficacy, utilization rates, andbarriers to implementation. Particular focus is given to logistical andsystems-based challenges limiting real-world application, including issues withdrug availability, perioperative workflow, and post-resection coordination. Wealso discuss implementation strategies informed by an implementation scienceframework, including planning and system engagement, executing interventions,and evaluating their impact within hospital systems. Incorporating SI-IVC into routine practicerequires pragmatic, system-level changes that address logistical barriersrather than clinical hesitancy. With institutional support and streamlinedprotocols, SI-IVC can be more consistently delivered; however, local adaptationand fine-tuning remain essential, as healthcare systems and available personnelvary across institutions.