The management of high-risk non-muscle-invasive bladder cancer(NMIBC) presents a significant challenge to many physicians, due to the ability of the disease to resist intravesical BCG therapy and the substantial rate of progression to the muscle-invasive bladder cancer. In the current literature, the alternative treatment modality for patients with BCG-unresponsive bladder cancer is radical cystectomy, which has a significant impact on the quality of life. In addition, the global shortage of BCG, which has become more apparent in recent years, has increased the necessity for new treatments. In this book chapter, we discussed new and current treatment modalities in high-risk NMIBC.