Bladder cancer is the fifth most common cancer in the Western world and is on the rise. Most patients present with superficial disease and are treated by transurethral resection of bladder tumor. More than half of these patients experience recurrence with about 20% progressing to muscle invasive disease. Intravesical chemotherapy has been shown to decrease the risk of recurrence of bladder cancer. Mitomycin C has emerged as a major agent for an immediate post-resection intravesical instillation. This article reviews the literature on the mode of action, rationale for immediate adjuvant treatment with Mitomycin C and adverse effects associated with its use.