Beyond the Rotisserie: Dispelling the Myths of Intravesical Therapy and Pioneering a Precision Future for Bladder Cancer

Abstract

In the treatment of intermediate and high-risk non–muscle-invasive bladder cancer (NMIBC), intravesical therapy with Bacillus Calmette–Guérin or chemotherapy remains the gold standard. However, traditional methods involving patient repositioning and catheter retention lack robust evidence. A focused narrative review of international guidelines (European Association of Urology, American Urological Association, Canadian Urological Association) and PubMed-indexed literature was conducted to address the rationale, efficacy, and pharmacokinetics of intravesical delivery, with particular attention to patient rotation and catheter management. Available evidence does not demonstrate a clinically meaningful benefit of routine post-instillation patient rotation for intravesical therapy. Major international guidelines do not recommend routine patient rotation during intravesical dwell time. Dwell times beyond 1 hour show diminishing incremental benefit, and prolonged catheter retention may limit uniform urothelial contact. Modeling studies suggest increased volume may enhance mucosal penetration but must be balanced with patient tolerance. Contemporary practices increasingly support immediate catheter removal following instillation. Emerging data suggest that tumor grade and biological features may complement traditional stagebased risk stratification. It was concluded that routine patient repositioning during intravesical treatment dwell time is not supported by evidence; no scheduled turns are required, thereby improving comfort and adherence. Immediate catheter removal after instillation may optimize urothelial exposure and improve patient tolerability, while potentially reducing catheter-associated complications. Clamped Foleys should be reserved for patients unable to voluntarily retain fluid and should be removed at the earliest opportunity. Advances in tumor grading, molecular characterization, and cautiously applied artificial intelligence tools may further refine risk stratification and personalize intravesical therapy in the future.

Cite this article as: Khan MZ, Atta MA, Kotb A, Ismail A, Kotb A. Beyond the rotisserie: dispelling the myths of intravesical therapy and pioneering a precision future for bladder cancer. Urol Res Pract. 2026, 52, 0112, doi: 10.5152/tud.2026.25112.