Radical cystectomy, removing the bladder, is an option for high-risk non-muscle invasive bladder cancer (NMIBC) that resists BCG therapy or has features like high-grade tumors. While it offers better cancer control, this major surgery carries risks of urinary diversion, sexual dysfunction, and fatigue. Doctors and patients should carefully weigh the benefits and drawbacks of this treatment for high-risk NMIBC.