Treatment options for patients with non-muscle invasive bladder cancer (NMIBC) refractory to intravesical bacillus Calmette-Guerin (BCG) therapy is reviewed in this article based on the recent published literature. Although intravesical BCG is the best bladder sparing treatment option for NMIBC to prevent recurrence and progression, about 1/3 of cases are refractory to this treatment. At this point radical cystectomy is the standard treatment of choice. If this option is not feasible, intravesical chemotherapy with docetaxel or gemcitabine, the combination of BCG and interferon (INF)-a or device-assisted intravesical strategies, such as mitomycin-EMDA or chemohyperthermia are some of the candidates for further treatment.
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