Reverse Thermal Mitomycin Gel as a Nonsurgical Option

This segment returns to the patient case to explore alternatives to repeat surgery. The faculty explain that recurrent low-grade intermediate-risk disease has traditionally been managed with transurethral resection of bladder tumor followed by adjuvant therapy. Reverse thermal mitomycin gel now offers a chemoablative approach that provides prolonged mitomycin exposure to the bladder lining. The panel reviews results from the single-arm ENVISION trial, in which most patients had no evidence of disease at the first follow-up cystoscopy and many responders remained disease free over longer follow-up. Treatment requires no operating room or anesthesia and has no maintenance phase. The chilled liquid turns to a semisolid gel in the bladder, and the catheter is removed shortly afterward. Side effects such as painful urination, urgency, and blood in the urine are usually brief. After treatment, patients follow safety precautions, including sitting to urinate, flushing multiple times, washing, and hydrating, and they must use contraception. The faculty emphasize that the gel is approved only for chemoablation in low-grade intermediate-risk disease.