From the view point that total cystectomy is important in treatment of carcinoma in situ (CIS) of the bladder, we reviewed the cases showing resistance to bacillus Calmette-Guerin (BCG) among 42 CIS treated with intravesical BCG. Twenty-six cases were cured by BCG treatment. Twelve total cystectomies were done in 16 cases of BCG-resistant CIS of the bladder. Four died with urethral invasion or upper urinary tract recurrence. There was invasion into the prostate in 3 cases. The development of CIS to the upper urinary tract and the prostatic urethra is not rare and this has an influence on the prognosis. In bladder CIS treatment, the inspection to see extravesical progression is necessary. It is important not to delay the radical cystectomy.