Objective To investigate the efficacy and safety of intravesical hyperthermic perfusion with gemcitabine and pirarubicin in the elderly patients with superficial bladder cancer after transurethral resection of bladder tumor (TURBT). Methods A retrospective analysis was made of 90 elderly patients with superficial bladder cancer treated with TURBT in the Department of Urology Surgery of Beijing Geriatric Hospital from April 2012 to April 2015. They were divided into gemcitabine group and pirarubicin group, with 45 in each group. In the former, a plastic bag of 500 ml sodium chloride solution (0.9%) added with 1000 mg gemcitabine was heated to 50℃. In the latter, a plastic bag of 500 ml glucose solution (5%) added with 40 mg pirarubicin was heated to 50℃. All the patients were perfused at 300 ml/min within 6 hours after operation for 1 hour, then once a week for 8 times, and once a month for one year. The 2 groups were compared in the recurrence rate, recurrence-free survival time and adverse reactions. SPSS statistics 17.0 was used for data analysis, and Student′s t test or Chi-square test for comparison between groups. Kaplan-Meier survival curves were made for survival time without recurrence and Log-rank test was performed for comparison. Results All patients were followed up for 12-36 months. No significant differences were observed between the 2 group in recurrence rate at 12 months [8.89%(4/45) vs 15.56%(7/45), P=0.334] and at 36 months [15.56%(7/45) vs 28.89%(13/45), P=0.128]. Compared with pirarubicin group, the gemcitabine group had longer recurrence-free survival time [(32.99±1.53) vs (27.71±1.95) months] and lower incidence of total adverse reactions [42.2%(19/45) vs 97.8%(44/45), P<0. 05]. Statistically significant differences were observed between the 2 groups in the incidence of hematuria, urinary pain and cystitis (P<0.05). Conclusion Intravesical hyperthermic perfusion of gemcitabine after TURBT has satisfactory efficacy with mild adverse reactions, serving as an effective way to prevent postoperative recurrence in the elderly patients with superficial bladder cancer.