Objective: Review management of bacillus Calmette-Guérin (BCG) failures in superficial bladder cancer.
Method: Search of published literature and meeting abstracts.
Results: Patients in whom BCG fails are not a uniform group. Failure cannot be predicted but high-risk patients can be identified. In case of failure and progression the outcome is bad. Conservative but investigative alternatives are BCG/interferon-alpha, intravesical hyperthermia/chemotherapy, or photodynamic therapy. Standard treatment in failing patients remains cystoprostatectomy.
Conclusion: BCG failures need careful and individualized therapy in experienced hands.