In general, medical specialists are cautious as to the introduction of new medical technologies. That is only natural as new techniques often involve unidentified risks. In addition, one may call into question whether it is justified to deny a patient the accepted "gold standard treatment" and to treat him/her with an unknown, unproven method. The EMDA treatment does not have to entirely substitute an existing treatment; it adds something extra.
Another reason for this treatment to be not used in every hosptal is the critical attitude towards the scientific EMDA publications: these papers have mainly been published by one group of hospitals in Italy. In the 'world of scientists' it is important that positive results reported by one single research group have been reproduced by another research group in order to accept the results as 'valid'. However, the good news is that, in the United Kingdom, a research group also showed positive results of EMDA with Mitomycine in the treatment of 'high-risk' patients in June 2012.
So far, the EMDA treatment has not been registered in the official European and Dutch treatment regulations for superficial bladder carcinoma. Specialists are considered to take these into account but may deviate from them if they have good reasons to do so. The modification of regulations is a long process. Professor Oosterlinck from Ghent (Belgium), until recently Chairman of the European regulation group 'Superficial Bladder Carcinoma' wrote in a recent article that publications about EMDA have to be taken seriously. Meanwhile he has started the treatment in Belgium too.
The use of EMDA catheters leads to extra costs that are, so far, not covered by most of the health insurers.