Bladder cancer ranks fourth in the incidence of malignant tumors in men, accounting for 6% of malignant tumors; the incidence in female patients is lower than that in men, about one-third of that in men. It is the fourth most common malignancy causing death (spectrum of tumor causes of death), accounting for about 4%. Bladder cancer is the most common malignancy in urology, but not the most fatal urological malignancy (kidney cancer is first). Its median age of onset is about 65 years old, and it tends to be rare under 40 years old, but due to the special national conditions in China, bladder cancer patients under 40 years old are not rare. The vast majority of bladder tumors are uroepithelial carcinoma, which is originally called metastatic cell carcinoma. In addition, squamous carcinoma accounts for about 3%, adenocarcinoma for 1.4%, small cell carcinoma for 1%, and some more rare pathological types, and this article focuses on uroepithelial carcinoma. Bladder cancer can be divided into non-muscle invasive (superficial) and muscle invasive bladder cancer, which can progress further through the bladder and involve surrounding tissues and organs (fat, prostate, uterus, rectum, pelvis, etc.), as well as lymph nodes and distant organ metastases. Fortunately, 70% of bladder cancers are non-muscle invasive bladder cancers at the time of initial diagnosis, and most of these patients can be treated by transurethral resection of bladder tumors, which is a minimally invasive treatment modality. As for bladder cancer with muscle layer invasion, the current standard treatment is radical cystectomy + pelvic lymph node dissection, which requires urinary diversion, which is the current gold standard for the treatment of muscle layer invasive bladder cancer. This article refers to progressive bladder cancer for patients with tumor involvement of the muscularis propria or deeper, but without involvement of the organs surrounding the bladder, and without evidence suggestive of lymph node and distant metastases. Since the standard treatment for progressive bladder cancer is total bladder resection and urinary diversion, why should bladder preservation be considered? 1, the bladder is an organ responsible for storing and emptying urine, and no other human tissue or organ can replace its function; 2, whatever the urinary diversion method (ileal bladder, in situ bladder) will be accompanied by certain complications (infection, fluid retention, urinary retention, electrolyte disturbance, acid-base imbalance, etc.); 3, whatever the diversion method will be accompanied by a reduced quality of life (stoma care, regular 3. Regardless of the technical means used, the vast majority of patients will lose their sexual function after radical cystectomy; 5. Radical cystectomy is a major surgery, with more complex techniques and more postoperative complications, which not all patients can tolerate. It is based on the above unfavorable considerations that the treatment of progressive bladder cancer with preservation of the bladder has recently emerged internationally. Surgical treatment tends to become smaller and smaller in terms of surgical approach, the most typical example being breast cancer. In the initial stage, in addition to removal of the breast, the pectoralis major and minor muscles and all the lymph nodes in the region had to be removed, but now, with the advent and progress of radiotherapy, chemotherapy and targeted therapy, the scope of surgery has been narrowed and breast-conserving surgery has even become mainstream for suitable patients. If we are trying to preserve a “face” organ, shouldn’t we give up on a more important organ like the bladder? According to the literature, the dream of preserving the bladder can be achieved for some patients with progressive bladder cancer through a combination of surgery, radiotherapy, chemotherapy, and adequate follow-up and review strategies. The complete response rate (disappearance of tumor without signs of recurrence) with combined treatment is 59%-81%, while the 5-year survival rate ranges from 50%-70%, which is not significantly inferior to total bladder resection. Moreover, in patients initially treated with bladder preservation and found to have tumor recurrence or progression during follow-up, the survival rate was not significantly lower when salvage cystectomy was performed. Therefore, bladder-sparing treatment is an appropriate treatment strategy for patients who have been carefully selected. However, it should be noted that for patients with progressive bladder cancer, radical cystectomy + pelvic lymph node dissection + urinary flow diversion remains the gold standard of treatment. The use of bladder-preserving treatment inevitably entails the risk of developing disease progression and disease metastasis, and the corresponding economic burden will increase, so patients should be fully informed, integrate the pros and cons, and make their own choices.