Ep. 340 Understanding Intermediate-Risk Bladder Cancer with Dr. Wesley Yip

By one estimate, half or more of all non-muscle invasive bladder cancer (NMIBC) is intermediate risk, yet the major guidelines still do not define it the same way, which leaves urologists sorting a large, mixed group of patients without a shared playbook for when to resect again, treat in the office, or start intravesical therapy. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Wesley Yip, urologic oncologist at City of Hope, to rethink what she calls the forgotten stepchild of bladder cancer: intermediate-risk non-muscle invasive bladder cancer (NMIBC). Dr. Yip explains why he sees the category as a catch-all rather than a single biological entity, by his estimate covering 50 to 60 percent of NMIBC, why he now relies on the International Bladder Cancer Group (IBCG) definition, and why tumor grade comes first, ahead of multiplicity, size, and recurrence timing. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:24 - Defining Intermediate-Risk NMIBC 07:53 - Case Presentation and the Initial TURBT 10:42 - Evaluating the First Recurrence 13:09 - High-Grade Cytology and Blue Light Cystoscopy 15:01 - The Burden of Repeat TURBT 16:57 - Office Fulguration and Chemoablation 20:23 - Chemoablation Tolerability and Patient Selection 24:24 - Intravesical Chemotherapy and Treatment Barriers 28:08 - New Formulations and Upcoming Trials 33:12 - Recurrence After Chemoablation and De-escalation 38:00 - Future Directions and Patient-Centered Endpoints 42:39 - Closing Remarks --- More about this episode Working through the case of a healthy 67-year-old man with recurrent low-grade Ta disease, the two discuss what to document at the first resection, how to counsel patients, when to return to the operating room, and when office fulguration, intravesical chemoablation, or intravesical chemotherapy with gemcitabine and docetaxel makes more sense. They cover the cumulative burden of repeat transurethral resection, practical lessons from bringing chemoablation into the clinic, how to read new trial data, and when to de-escalate surveillance. Dr. Yip closes with his hopes for the next five years: a biology-based definition and trials that measure fewer recurrences, fewer procedures, and better quality of life. --- Resources Intermediate-risk Non-muscle-invasive Bladder Cancer: Updated Consensus Definition and Management Recommendations from the International Bladder Cancer Group. Eur Urol Oncol. 2022 https://pubmed.ncbi.nlm.nih.gov/35718695/ Intermediate-risk Non-muscle-invasive Bladder Cancer: Recommendations for Definitions, Risk Stratification, Management Strategies, and Clinical Trial Design from the International Bladder Cancer Group. Eur Urol Oncol. 2025 https://pubmed.ncbi.nlm.nih.gov/41076366/ All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors. J Urol. 2022 https://pubmed.ncbi.nlm.nih.gov/35770498/ Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline https://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-muscle-invasive-guideline EAU Guidelines on Non-muscle-invasive Bladder Cancer https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer Bladder Cancer Advocacy Network (BCAN) https://bcan.org Dr. Wesley Yip, City of Hope physician profile https://www.cancercenter.com/physician-directory/wesley-yip Dr. Ruchika Talwar, BackTable Urology contributor page https://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app