Objective:

To review management of intravesical bacillus Calmette-Gue'rin (BCG) failures in first step therapy for non muscle invasive bladder cancer

Method:

Search of published articles, reviews, textbooks and meeting abstracts.

Results:

Intravesical BCG is recommended as adjuvant treatment in patients with high risk, intermediate risk in whom intravesical chemotherapy failed and also primary treatment at carcinoma in situ (CIS). Between 20-40 % of patients apparently fail after BCG with recurring tumors or can not tolerate BCG, depending on the follow up time and their initial risk profile. Althought new chemotherapeutic and immunotherapeutic drugs, electromotive drug administrations, thermo-chemotherapy and photodynamic therapy are alternative treatment options, their success are controversial and there aren't any standard treatment algorithms. Therefore, treatment is recommended keeping in mind rate of profit loss. Cystectomy is the most effective treatment in patients with high risk in whom intravesical BCG failed, however it's controversial because radical surgery has high mortality and morbidity and it's over-treatment for some patients. It needs results of larger series and more long-term studies to show value of these treatment strategies in patients with BCG failures.