Intravesical bacillus Calmette-Guerin (BCG) therapy is the gold standard treatment option in high-risk non-invasive bladder cancer. However, BCG is a very toxic agent. A significant proportion of patients have BCG intolerance after beginning intravesical treatment. Radical cystectomy is the recommended approach for patients with either BCG failure or BCG intolerance. Alternative intravesical salvage treatments are needed for patients who cannot tolerate radical cystectomy due to comorbidities or who refuse surgery.,In this review, current intravesical treatment alternatives to radical cystectomy in intravesical BCG failure are discussed with oncologic outcomes.