Bladder cancer is the most common malignant tumor of the urinary system in China, and the incidence and death rate have been increasing year by year in recent years.In 2015, there were 74,362 new cases of bladder cancer in China, accounting for 1.73% of all systemic tumors, and there were 29,349 deaths from bladder cancer, accounting for 1.02% of all tumor deaths, with a mortality morbidity ratio of 39.46% and a 5-year survival rate of 67.3%. Data show that about 20%~40% of bladder cancers are muscle invasive bladder cancer (MIBC) at the initial diagnosis, and radical cystectomy (RC) is an effective means of treating MIBC, but about 20%~25% of these patients have lymph node metastasis at the time of RC surgery, especially the depth of invasion of the primary tumor is closely related to the probability of lymph node metastasis. Therefore, pelvic lymph node dissection (PLND) is a necessary step for RC surgery in MIBC, and it is essential for performing accurate tumor staging, judging patients’ prognosis, deciding on adjuvant radiotherapy, avoiding recurrence and metastasis, and improving patients’ survival rate. Individualized LN clearance is currently the best diagnostic and treatment strategy for bladder cancer diagnosis and treatment LN metastasis of bladder cancer has a strong relationship with the clinical stage and grading of the tumor, the chance of lymph node metastasis is relatively low in low-grade and early-stage tumors, and the risk of lymph node metastasis increases as the grade of bladder cancer increases. As shown in the table below: Currently, preoperative imaging examinations including CT, MRI and even PET-CT have a limited role in accurately determining whether local or even distant lymph node metastasis has occurred in bladder cancer, therefore, intraoperative exploration and postoperative pathology test results are of great significance in accurately determining patients’ tumor staging. During the period, the number of lymph nodes obtained during the PLND procedure is crucial for the pathology department to determine whether MIBC has lymph node metastasis. The number of lymph nodes obtained during PLND surgery reported in the literature varies greatly, which is influenced by the operator’s grasp of the tumor stage and surgical scope, the way of delivering the surgical specimen (e.g., whether the whole piece is excised or separately excised and then bagged and delivered for examination), as well as the pathologist’s handling of the specimen and his experience in judging the specimen. However, it is indisputable that the greater the number of lymph nodes obtained surgically, the greater the accuracy in determining whether lymph node metastasis has occurred in MIBC. For that matter, the increase in the total number of lymph nodes resulting from the expansion of the PLND will undoubtedly enhance the accuracy of the pathologic diagnosis. The extent of LN dissection, on the other hand, should be determined according to the clinical staging and tumor grading; for non-muscle invasive bladder cancer, we can implement standard dissection or expanded dissection, and for locally advanced patients, we need to do super-expanded dissection. According to this principle, we can accurately grasp the situation of lymph node metastasis, which is also very helpful for the patient’s prognosis. It is still controversial whether to perform LN clearance, there are many patients, cut too little to detect LN metastasis, but in fact, LN metastasis has occurred, and there is no consensus on whether expanded clearance patients benefit. Therefore, individualized LN clearance is currently the best strategy. “Bladder preservation” needs to ensure clean resection and triple combination therapy In attempting to carry out bladder preservation treatment, choosing a reasonable surgical plan according to the individual differences of patients is the key to bladder cancer treatment. At present, the surgical treatment options for bladder preservation attempted by scholars at home and abroad mainly include: transurethral resection of bladder tumor (TURBT), holmium laser resection of bladder tumor (HOLRBT), partial cystectomy, and so on. For the treatment of bladder preservation, there has been a partial consensus reached. Firstly, the surgery for bladder preservation must ensure that the tumor can be cut cleanly, and the location of the tumor must not be in the periphery of the ureter, otherwise it will be difficult to remove it cleanly. Secondly, it is important to emphasize the triple combination of surgery, chemotherapy and radiotherapy together. In addition, radiotherapy needs equipment and good techniques, and requires high requirements on the setting of target area and dose distribution, so hospitals that cannot meet the conditions should not make a hasty attempt of bladder preservation treatment. Bladder cancer treatment still has a long way to go China has a vast area, the level of bladder cancer treatment varies among hospitals at all levels and in all regions, and the diagnosis and treatment standard is not in place, our large hospitals are obliged to promote the diagnosis and treatment standard; The quality of electrocision and pathological examination is very important, if no muscle is seen in the electrocision specimen, it is impossible to judge whether it is non-muscle layer invasive bladder cancer or muscle layer invasive bladder cancer, then a second electrodesiccation must be performed, which has a significant impact on the later comprehensive treatment strategy. There is no very good way to ensure the effect of bladder-preserving treatment for limited muscle invasive bladder cancer. For metastatic bladder cancer, there used to be only cisplatin-based chemotherapy, but now there is immunotherapy, especially the combination of PD-1 and PD-L1 pathway inhibitors and chemotherapy, which has given us a glimmer of light. Therefore, the diagnosis and treatment of bladder cancer in China still has a long way to go!