Urologic Oncology · University Urology, PC

Advanced Bladder Cancer Treatments in Knoxville, TN

Comprehensive care from diagnosis through survivorship — non-muscle invasive and muscle-invasive bladder cancer, upper tract urothelial carcinoma, and access to the newest intravesical therapies available.

Request a Consultation Call (865) 305-9254
Fellowship-Trained Urologic Oncologists
BCG, Anktiva, Adstiladrin, INLEXZO, Zusduri
Cystectomy & Bladder Reconstruction
Jelmyto for Upper Tract UCC
Stage 1
TURBT & Diagnosis
All urologists · tissue staging
Stage 2
NMIBC Management
Intravesical therapy & surveillance
Stage 3
Advanced & MIBC
Cystectomy & systemic therapy
Stage 4
Survivorship
Surveillance & recurrence management

East Tennessee’s Bladder Cancer Specialists

Comprehensive Bladder Cancer Care — From First Diagnosis to Survivorship

Bladder cancer is the most common urologic malignancy in the United States after prostate cancer, and its management has evolved significantly in recent years. From novel intravesical therapies for BCG-unresponsive non-muscle invasive disease to robotic cystectomy with neobladder reconstruction, the range of effective options has never been wider — but navigating them requires subspecialty expertise.

University Urology offers the full spectrum of bladder cancer care at the University of Tennessee Medical Center in Knoxville. Our team includes fellowship-trained urologic oncologists who manage complex NMIBC, perform cystectomy, and coordinate with medical and radiation oncology for patients requiring multimodal treatment.

New diagnosis, BCG failure, recurrence, or seeking a second opinion — we see patients at all stages. Urgent consultations are available.

Conditions We Treat

From Low-Grade NMIBC to Complex Muscle-Invasive Disease

Our team manages the full spectrum of bladder and upper tract urothelial malignancy:

  • Non-muscle invasive bladder cancer (Ta, T1, CIS) — all risk categories
  • BCG-unresponsive and BCG-relapsing NMIBC
  • Muscle-invasive bladder cancer (T2–T4)
  • Locally advanced and metastatic urothelial carcinoma
  • Upper tract urothelial carcinoma (renal pelvis, ureter)
  • Recurrent disease after prior treatment elsewhere
  • Bladder cancer survivorship and long-term surveillance

Important Notice

BCG National Shortage

BCG supply is currently limited nationally

BCG (Bacillus Calmette-Guérin) is the standard intravesical immunotherapy for high-grade non-muscle invasive bladder cancer, and an ongoing national manufacturing shortage has limited availability across the country. This is not specific to University Urology — it affects urology practices everywhere.

We maintain an active waitlist and work to ensure every patient who needs BCG receives it as soon as supply becomes available. If you are waiting for BCG treatment, please know your place is held and our team is actively managing access on your behalf.

We are also currently enrolling patients in a clinical trial for recombinant BCG, which may allow for increased access to BCG-based therapy. Ask your physician whether you may be a candidate. To learn more or get on the waitlist, send us a message through Klara or call (865) 305-9254.

From Our Team

Bladder Cancer Basics with Dr. Bienvenu

Dr. James M. Bienvenu walks through the fundamentals of bladder cancer — how it is diagnosed, how risk is stratified, and what treatment options are available depending on stage and grade. Whether you are newly diagnosed or accompanying a family member, this overview is a helpful starting point before your consultation.

Topics covered include TURBT, intravesical therapy, BCG and newer agents, and when more advanced treatment such as cystectomy may be needed.

Treatment Pathways

Personalized Treatment Across Every Stage

Treatment selection depends on tumor stage, grade, prior therapy history, pathology findings, and overall health. We discuss all appropriate options and make a clear recommendation based on your individual situation.

Non-Muscle Invasive (NMIBC)

TURBT & Intravesical Therapy

The foundation of NMIBC management is thorough transurethral resection (TURBT) for diagnosis and staging, followed by risk-stratified intravesical therapy. All of our urologists perform TURBT. Advanced NMIBC cases are typically managed by Drs. Angelle, Bienvenu, and White.

  • TURBT — performed by all University Urology physicians
  • BCG induction and maintenance therapy
  • Anktiva (N-803) with BCG for appropriate patients
  • Zusduri for select intermediate-risk NMIBC
  • Adstiladrin (nadofaragene firadenovec) for BCG-unresponsive CIS
  • INLEXZO (TAR-200) — sustained-release intravesical gemcitabine for BCG-unresponsive CIS
  • Alternative intravesical chemotherapy as indicated
Muscle-Invasive (MIBC)

Cystectomy & Bladder-Sparing Strategies

Muscle-invasive bladder cancer requires prompt, definitive management. Radical cystectomy with urinary diversion remains the gold standard for most patients. Bladder-sparing approaches using trimodal therapy (TURBT, chemotherapy, radiation) are an option for carefully selected patients.

  • Radical cystectomy — Dr. Angelle and Dr. Bienvenu
  • Robotic-assisted cystectomy with neobladder or ileal conduit
  • Neoadjuvant chemotherapy coordination prior to surgery
  • Trimodal bladder-preservation therapy for select patients
  • Coordination with medical and radiation oncology at UTMC
Upper Tract Urothelial Carcinoma

Kidney & Ureter-Sparing Options

Upper tract urothelial carcinoma involving the renal pelvis or ureter requires a tailored approach based on tumor grade, location, and kidney function. We offer both endoscopic organ-sparing options for appropriate low-grade cases and nephroureterectomy for high-grade or extensive disease.

  • Jelmyto (mitomycin gel) — kidney-sparing treatment for low-grade upper tract UCC
  • Ureteroscopic management for select low-grade cases
  • Robotic nephroureterectomy for high-grade or extensive disease
  • Multidisciplinary review for complex cases
Survivorship & Surveillance

Long-Term Monitoring & Recurrence Management

Bladder cancer has one of the highest recurrence rates of any malignancy, making structured surveillance essential. We develop individualized follow-up plans based on risk category and treatment history, and manage recurrence promptly when it occurs.

  • Cystoscopy surveillance on risk-stratified intervals
  • Urine cytology and enhanced urine markers
  • Upper tract imaging as indicated
  • Cross-sectional imaging for post-cystectomy surveillance
  • Recurrence management and second-line therapy coordination

Intravesical Therapies

Access to the Full Range of Modern Intravesical Options

The treatment landscape for non-muscle invasive bladder cancer has expanded significantly. We offer all guideline-supported intravesical therapies, including several newer agents that are not yet available at every center.

Immunotherapy

BCG (Bacillus Calmette-Guérin)

The established standard of care for intermediate- and high-risk NMIBC. Induction and maintenance BCG reduces recurrence and progression risk in appropriately selected patients.

Immunotherapy + IL-15

Anktiva (N-803) with BCG

An IL-15 superagonist used in combination with BCG for patients with BCG-unresponsive NMIBC with CIS. FDA-approved and available at University Urology for appropriate candidates.

Gene Therapy

Adstiladrin (Nadofaragene Firadenovec)

FDA-approved intravesical gene therapy for BCG-unresponsive high-risk NMIBC. Delivers interferon alfa-2b gene directly into bladder cells. A bladder-sparing option for patients who have failed BCG.

New — BCG-Unresponsive

INLEXZO (TAR-200)

A sustained-release intravesical drug delivery system that releases gemcitabine continuously over approximately three weeks per cycle. FDA-approved for BCG-unresponsive NMIBC with CIS — a bladder-sparing alternative to cystectomy for appropriate patients.

Intravesical Chemotherapy

Zusduri & Alternative Agents

Zusduri (UGN-102, mitomycin gel) for select intermediate-risk NMIBC. Traditional intravesical chemotherapy agents (mitomycin C, gemcitabine) remain appropriate for certain indications and risk categories.

Systemic Chemotherapy

Neoadjuvant & Systemic Therapy

Cisplatin-based neoadjuvant chemotherapy prior to radical cystectomy for eligible MIBC patients. Coordination with medical oncology for systemic therapy in advanced and metastatic disease.

Upper Tract Urothelial Carcinoma

Jelmyto — Kidney-Sparing Treatment for Low-Grade Upper Tract UCC

Jelmyto (mitomycin for pyelocalyceal solution) is an FDA-approved reverse thermal gel that delivers mitomycin directly to the renal pelvis and ureter, providing localized treatment for low-grade upper tract urothelial carcinoma without removing the kidney. University Urology performs a significant volume of Jelmyto instillations and has established protocols for appropriate patient selection and follow-up.

How It Works

Jelmyto is instilled as a liquid through a catheter placed into the renal pelvis. At body temperature, the gel solidifies and maintains prolonged contact with the urothelial lining, allowing mitomycin to act locally over an extended dwell time — something not achievable with traditional instillation techniques.

Who May Be a Candidate

  • Low-grade upper tract urothelial carcinoma of the renal pelvis or ureter
  • Solitary kidney or bilateral disease where nephroureterectomy would result in dialysis dependence
  • Patients who wish to preserve kidney function when oncologically appropriate
  • Select patients following endoscopic resection of upper tract tumors

Treatment Protocol

  • Weekly instillations for 6 weeks (induction course)
  • Performed as an outpatient procedure at UTMC
  • Ureteral stent typically placed prior to initiation
  • Close ureteroscopic surveillance during and after treatment

Important Considerations

  • Not appropriate for high-grade upper tract disease
  • Requires careful patient selection and multidisciplinary review
  • Ureteral stricture is a known complication — monitored closely
  • Does not replace nephroureterectomy when that is the oncologically correct approach

Our Team

Physicians Managing Bladder Cancer at University Urology

TURBT is performed by all of our urologists. Advanced NMIBC and muscle-invasive disease are managed by our fellowship-trained oncologists.

Advanced NMIBC & Muscle-Invasive Disease

JA

Dr. Jonathan Angelle, MD

Urologic Oncology · Robotic Surgery
Cystectomy · Advanced NMIBC

Full Profile →
JB

Dr. James M. Bienvenu, MD

Urologic Oncology Fellowship
Cystectomy · Advanced NMIBC · UTUC

Full Profile →
WW

Dr. Wesley M. White, MD

Urologic Oncology · Dept. Chair
Advanced NMIBC · TURBT

Full Profile →

TURBT is performed by all University Urology urologists — including Drs. Angelle, Bienvenu, White, Riedinger, Pickens, Kim, and Lacy. Initial evaluation and ongoing surveillance can be managed across our team, with complex or high-risk cases referred internally to our oncology-focused physicians as appropriate.

Treatment at a Glance

Bladder Cancer Treatment Summary

This table is a general guide. Individual treatment selection depends on a complete evaluation.

Scroll left/right to view full table →

Setting Goal Options Key Physicians
TURBT Diagnosis & staging Transurethral resection of bladder tumor; tissue pathology All urologists
Low/Intermediate NMIBC Reduce recurrence BCG, intravesical chemo, Zusduri, surveillance All urologists; complex cases → Angelle, Bienvenu, White
High-Risk / BCG-Unresponsive NMIBC Bladder preservation or cystectomy Anktiva, Adstiladrin, INLEXZO (TAR-200), cystectomy Angelle, Bienvenu, White
Muscle-Invasive (MIBC) Definitive local control Radical cystectomy (robotic), neoadjuvant chemo, trimodal therapy Angelle, Bienvenu
Upper Tract UCC Organ preservation when feasible Jelmyto, ureteroscopy, nephroureterectomy Angelle, Bienvenu
Survivorship Early recurrence detection Cystoscopy, cytology, imaging surveillance programs All urologists

Frequently Asked Questions

Common Questions About Bladder Cancer Treatment

I was just diagnosed with bladder cancer. What happens next?
The first step after a bladder cancer diagnosis is usually a TURBT — transurethral resection of the bladder tumor. This both removes visible tumor and provides tissue for pathologic staging. Based on the stage and grade of the tumor, your urologist will recommend a treatment and surveillance plan. If your cancer is non-muscle invasive, intravesical therapy is usually the next step. If muscle-invasive disease is found, a cystectomy consultation will be arranged promptly.
What does BCG-unresponsive mean, and what are my options?
BCG-unresponsive disease means your bladder cancer has persisted or recurred despite adequate BCG treatment. This is a common and challenging clinical situation. At University Urology, we offer several bladder-sparing alternatives specifically approved for this setting: Anktiva (N-803) with BCG, Adstiladrin, and INLEXZO (TAR-200). For patients where bladder-sparing therapy is no longer appropriate, we discuss radical cystectomy and the reconstruction options available.
What is INLEXZO (TAR-200) and how is it different from regular gemcitabine?
INLEXZO is a small, flexible drug-delivery device placed into the bladder through a catheter. It releases gemcitabine continuously over approximately three weeks per cycle — achieving sustained drug levels in the bladder that are not possible with traditional short-dwell instillations. It is FDA-approved for BCG-unresponsive NMIBC with carcinoma in situ and offers a bladder-sparing alternative to cystectomy for patients who qualify.
What happens if I need my bladder removed?
Radical cystectomy removes the bladder and requires a urinary diversion. The two most common options are an ileal conduit (a urostomy with an external bag) and a neobladder (an internal reservoir constructed from bowel that allows voiding through the urethra). Drs. Angelle and Bienvenu perform robotic-assisted radical cystectomy at UTMC and will discuss which reconstruction is most appropriate for your anatomy, overall health, and goals.
What is Jelmyto and who is it for?
Jelmyto is an FDA-approved mitomycin-containing reverse thermal gel for low-grade upper tract urothelial carcinoma — cancer of the renal pelvis or ureter. It is instilled through a catheter and solidifies at body temperature, allowing prolonged drug contact with the urothelial lining. It is a kidney-sparing option appropriate for selected patients with low-grade disease. It is not appropriate for high-grade upper tract tumors, where nephroureterectomy remains the standard approach.
How long do I need surveillance after treatment?
Bladder cancer surveillance is lifelong for most patients given the high recurrence rate. The frequency of cystoscopy and imaging depends on your risk category and treatment history. Low-risk NMIBC may be monitored with less frequent cystoscopy over time. High-risk NMIBC and post-cystectomy patients require more intensive, long-term follow-up. Your urologist will outline a specific surveillance schedule at your post-treatment visit.
How do I get started?
Message us through Klara, call (865) 305-9254, or ask your referring provider to send a referral. For new diagnoses or suspected bladder cancer, urgent appointments are available. Please bring any prior pathology reports, operative notes, and imaging when you come in — this allows us to begin planning your care at the first visit.

Financial Resources

Financial Assistance for Bladder Cancer Treatment

Bladder cancer treatment — including intravesical therapy, immunotherapy, and surgery — can carry significant out-of-pocket costs. Several independent nonprofit organizations offer copay assistance, insurance premium support, and grant funding for eligible patients. Fund availability changes frequently; programs open and close based on funding. We encourage patients to check directly and join waitlists when funds are closed.

Our team can help connect you with these resources. Send a message through Klara and ask to speak with our financial counselor.

Copay Assistance

PAN Foundation — Bladder Cancer Fund

Copay grants up to $15,400/year for eligible patients. Fund opens and closes based on availability — join the waitlist when closed. PAN Foundation and Patient Advocate Foundation announced a merger in March 2026; programs continue uninterrupted.

Apply or join waitlist →

Copay Assistance

PAF Co-Pay Relief — Bladder Cancer

Direct copay, coinsurance, and deductible assistance for insured bladder cancer patients. Covers all stages and histologic subtypes. Fund availability varies — check status before applying.

Check availability →

Copay Assistance

The Assistance Fund (TAF) — Bladder Cancer

Copay, coinsurance, and deductible assistance for bladder cancer medications. Fund availability changes frequently — check current status and join the waitlist if closed.

Check availability at tafcares.org →

Medicare Patients

HealthWell Foundation — Bladder & Urothelial Cancers

Copay and premium assistance specifically for Medicare patients with bladder or urothelial cancer. Fund opens and closes based on available funding — check status often and apply when open.

Check availability →

Note: Fund availability changes frequently. Programs open and close based on donations and demand. We recommend checking each program directly and joining waitlists when funds are temporarily closed. Our team is happy to assist — message us through Klara for guidance.

New Diagnosis, BCG Failure, or Seeking a Second Opinion?

We see bladder cancer patients at all stages. Urgent consultations available. Message us or call to get started.

Message Us on Klara Call (865) 305-9254 Text Us Meet Our Team

Preparation Instructions

Preparing for Your Procedure

Select the preparation guide that applies to your scheduled treatment.

In-Office Treatment

Intravesical Therapy

BCG, Anktiva, Gemcitabine, Gem/Doce, Adstiladrin, and Zusduri — preparation, hold times, waste handling, and what to expect at each instillation visit.

View preparation instructions → Hospital Surgery

Cystectomy with Ileal Conduit

PAT testing, medication and fasting instructions, hospital stay expectations (5–10 days), stoma care, and recovery guide.

View preparation instructions →

Need directions to UTMC for your surgery or PAT appointment? See Getting to UTMC.