How do you approach a patient with inoperable urothelial carcinoma of the bladder with persistent non-muscle invasive disease despite intravesical BCG/IFN and intravesical chemotherapy?

T1 high grade urothelial carcinoma, with persistent disease after intra-vesicular therapy (e.g., BCG) is an aggressive disease and progression to invasive urothelial cancer is common. This entity tends to be multifocal / diffuse and transurethral resection (TURBT) alone is often inadequate as defini...