Bladder tumors are characterized by easy recurrence, and even after surgery, systematic, timely, and adequate courses of bladder irrigation chemotherapy drugs still recur in nearly 30% of patients, and the malignancy of the tumor deepens to varying degrees with each recurrence. Therefore, we recommend total cystectomy with orthotopic (in situ) bowel replacement bladder for patients with multiple or large tumors or multiple recurrences, if physically possible. There are more than 500 patients who underwent total cystectomy in our hospital, and there are only 19 cases of recurrence (including intraoperative tumor lymph node metastasis, squamous epithelial carcinoma and adenoid epithelial carcinoma), 2 cases of untreated urinary leakage, 12 cases of hydronephrosis and 2 cases of intestinal leakage; the rest of them recovered to health and can urinate on their own without affecting the quality of life; the majority of young male patients have normal sexual function. Therefore, total cystectomy is not an incurable disease. On the other hand, in my personal opinion, do not believe in X- or Y-knife treatment for large tumors or recurrent tumors. There are several cases in which patients who had such treatment outside the hospital delayed treatment and came to our hospital because the tumor involved the surrounding area and could not be operated, which is regrettable.