This information gives you an overview of intravesical thermo-chemotherapy. It also gives details on how it is given, common side effects and how to manage them. If you have any concerns or would like further information, contact your urology doctor or clinical nurse specialist (CNS). Their contact details are below.
You can find information about bladder cancer on the Macmillan Cancer Support website. Please ask your CNS if you would like a printed copy of the information.
This treatment uses a chemotherapy called Mitomycin C, which is put directly into your bladder. It is called thermo-chemotherapy because we warm it once it's in your bladder. Sometimes your healthcare team will call this HIVEC treatment. Research shows that warming the chemotherapy can make the treatment more effective.
We can use intravesical thermo-chemotherapy if your bladder cancer is superficial. Superficial bladder cancer affects only the bladder lining, not the muscle. But it can sometimes develop into a more serious form of bladder cancer. The treatment works by slowing or stopping cancer cells from growing in your bladder. It also helps prevent cancer from coming back.
If you choose not to have this treatment, your urology doctor will discuss alternatives for you. Going without treatment could pose a serious risk to your life.
The most likely alternative treatment would be to continue with bladder surveillance. This means that you will have regular cystoscopies so we can check your bladder cancer. A cystoscope is a tube with a light and a tiny camera on the end. We use it to look inside your bladder.
If your cancer returns or spreads, we may offer you the following treatments:
- another transurethral resection of a bladder tumour (TURBT) procedure
- other intravesical treatments
- radiotherapy
- surgery to remove your bladder
Ask your CNS or doctor if you want more information about these treatments.
You will have this treatment during an outpatient appointment. This means that you will not need to stay in the hospital overnight and you can go home when your treatment is finished.
Tell your CNS if:
- you take diuretics – we may ask you to take them at a different time on the day of your treatment
- you or your partner are planning to become pregnant during the course of treatment
- you feel unwell on the day of the treatment or are unable to attend
Some people may need time off work to attend the treatment sessions. So please discuss this with your employer before your first treatment.
We want to involve you in all the decisions about your care and treatment. If you choose to have intravesical chemotherapy, we will ask you to sign a consent form before you have it. This confirms that you agree to have the treatment and understand what it involves. Staff will explain the risks, benefits and alternatives before you sign a consent form. If you are unsure about having the treatment, please tell your hospital doctor or CNS.
Your CNS will discuss with you in detail what will happen before, during and after your treatment. You will have time to ask questions.
Before your first treatment, we may ask you about the following, so it is helpful to have this information ready:
- any illnesses you’ve had in the past
- any operations you’ve had
- any allergies you have to medicines
- any medicines you’re currently taking
If you’ve had intravesical chemotherapy before, your CNS will ask you how you’ve felt since the last treatment. They will also ask you about any side effects you’ve had.
Do not drink anything for three hours before your treatment. This reduces the amount of urine in your bladder, which makes the chemotherapy stronger. It can also help you feel more comfortable during the treatment. If you feel thirsty, it’s ok to take sips of water.
You can eat as usual before having this treatment.
What happens before the treatment?
Your CNS will:
- make sure you’re lying in a comfortable position
- clean your genitals with antiseptic solution
- apply an anaesthetic gel into your urethra (water passage)
- insert a narrow tube, called a catheter, through your urethra into your bladder
- attach the catheter to the treatment machine
What happens during the treatment?
- The treatment machine warms the chemotherapy and circulates it into your bladder.
- During the first few minutes, you may notice a warm feeling in your bladder. When this happens, you may feel like you need to pee. As you have a catheter in place, there is no need to try to hold it in. The catheter will drain your bladder for you.
- The treatment lasts for 60 minutes. We will ask you to stay lying on the bed during this time. You’re welcome to bring something to help pass the time such as a book, magazine, crossword or electronic device.
- If you feel uncomfortable or have concerns during the treatment, tell your CNS.
What happens after the treatment?
- After 60 minutes the treatment system makes a bleeping sound. This signals that the treatment is complete.
- The chemotherapy drug will slowly drain from your bladder.
- Your CNS will remove your catheter.
- Although your bladder will be empty, you may feel like you need to pee. Your bladder is adjusting to the removal of the catheter, which is completely normal.
- We will discuss your next appointment before you leave.
- You can go home once you finish the treatment, and you feel ready.
Side effects usually start within three to four hours after treatment and last up to 24 hours. Tell your CNS or hospital doctor if you have severe pain during or immediately after your treatment. Common side effects include:
- Cystitis. You might feel pain or a burning feeling when you pee, need to pee more often than usual, or see blood in your urine. Don’t worry if this happens, as it is normal. It helps to drink plenty of fluids. Contact your GP if you have had these symptoms for more than three days.
- A body rash. This happens very rarely. If it does, please tell your CNS.
If you develop any of the following symptoms, immediately go to your local Emergency department (A&E):
- shortness of breath
- difficulty breathing
- face swelling
- severe tummy pain
- unable to pass any urine
- Drink 1 to 2 litres of fluid each day for the first couple of days after your treatment. This keeps your urine diluted, which will make your recovery more comfortable. It also reduces the chances of developing a urinary tract infection.
- Avoid caffeine drinks (such as tea and coffee), fizzy drinks and alcohol for the first couple of days after your treatment. These can irritate your bladder.
- Your urine may have small traces of chemotherapy for up to six hours after receiving it. So, it’s important to take some simple precautions during this time.
- We recommend that both men and women sit down when using the toilet as this reduces the risk of spills or splashes.
- Flush the toilet twice with the lid down each time you use it.
- Wash your hands with soap and water after you pee.
- If you get urine on your skin, wash the area with soap and water.
- If you can, take paracetamol or ibuprofen as this may help if you have bladder pain or discomfort. Please always read the instructions for use.
- Avoid sex or use a condom for 48 hours following each treatment.
Research shows that smoking can cause bladder cancer to come back. Speak to your CNS if you need support to stop smoking. Or visit nhs.uk/
At UCLH, the treatment is made up of two parts:
1. Induction regime
- You’ll have the treatment once a week for six weeks.
- After that, you’ll have a six-week break with no treatment. This is to allow your bladder to recover.
- You’ll then have a cystoscopy to assess how well the treatment worked. This is usually done under a general anaesthetic. You will normally stay in hospital for a short time after this, sometimes you may need to stay overnight. We arrange this appointment during your course of treatment. Contact your CNS if you don’t get the appointment.
- You’ll have an appointment with your urology doctor about three weeks after your cystoscopy. This is to discuss the results and your ongoing care plan.
2. Maintenance treatments
- After the cystoscopy at the end of your first course of treatment, we may recommend that you have more treatments.
- If we recommend more, we will give you a treatment every month for six to 12 months. This is to stop your cancer from coming back. Your urology doctor will review this every six months.
- Every three to six months, you’ll have a flexible cystoscopy to check if the cancer has come back. This is done under local anaesthetic in an outpatient appointment, so you won’t need to stay for long after you’ve had it. If you don’t know when you’re due for your next flexible cystoscopy, please contact your CNS.
Although treatment may differ between hospitals, all hospitals follow trusted, research-based guidelines.
Your CNS team organise and give you the treatment. You can contact them if you need to change an appointment or if you need support or advice. Their contact details are below.
Action on Bladder Cancer (ABC-UK)
0300 302 0085
ABC is a UK charity made up of healthcare professionals and patients. They are dedicated to improving the lives of people with bladder cancer and raising awareness of it.
British Association of Urological Surgeons (BAUS)
BAUS is a charity which promotes high standards in urology for patients. They have a range of information for patients about tests and treatments.
Fight Bladder Cancer
01844 351 621
Fight Bladder Cancer is a UK charity founded and run by bladder cancer patients and their families.
Macmillan Cancer Support
0808 808 0000 (7 days a week, 8am to 8pm)
Provides clear information, emotional support, and practical advice.
The Urology Foundation (TUF)
TUF is a UK charity that helps improve urological health and care. They offer clear information about bladder cancer symptoms, tests, and treatments. They also offer advice on life after cancer treatment.
If you have an urgent medical concern, contact your GP or call NHS 111.
If you need urgent medical attention, go to your nearest Emergency Department (A&E).
UCLH urology service contact details
You can contact the UCLH urology team Monday to Friday, 9am to 4pm (excluding public holidays).
For general enquiries, appointments, or hospital admissions, please contact the superficial bladder cancer and renal service:
For non-urgent clinical queries, contact your CNS:
- Richard Weston
0203 447 5134
richard.weston2@nhs.net - Kay Boyer
07977 079333
kay.boyer1 @nhs.net - Hilary Baker, lead clinical nurse specialist
hilary.baker2 @nhs.net
Services
Page last updated: 26 May 2026
Review due: 01 May 2028
