Big cities in developing countries often have problems managing their domestic wastewater. Indonesia as the fourth most-populated country in the world also faces many challenges regarding domestic wastewater management. Surabaya and Bandung are the second and third most-populated city in Indonesia, with a population of 2,765,908 and 2,393,633 respectively. As demand for urban domestic wastewater treatment systems increases, the decentralized wastewater treatment system is considered as an alternative which has big potential for implementation. This paper provides a brief review of urban domestic wastewater treatment approaches in Indonesia, especially in Surabaya and Bandung, and their potential of application in cities with similar characteristics. The alternative technologies reviewed in this paper include locally developed and accepted technology (such as septic tanks) and some new promising concepts which have not yet been well established in Indonesia (such as DEWATS or ecosan systems). Studies showed that despite high hygienic risk potential and low environmental performance, septic tanks were still most preferred by the community. It is crucial to ensure social, financial and technical sustainability of the alternative approaches, so that the option chosen to be applied can really be sustainable.