AccScience Publishing / Bladder / Online First / DOI: 10.14440/bladder.2024.0076
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REVIEW

Current status and advances in bladder-sparing treatment for non-metastatic muscle-invasive bladder cancer

Anbang Wang1 ,  Shancheng Ren1*
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1 Department of Urology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
Bladder, e21200062 https://doi.org/10.14440/bladder.2024.0076
Submitted: 15 December 2024 | Revised: 3 July 2025 | Accepted: 18 June 2025 | Published: 5 November 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Muscle-invasive bladder cancer (MIBC) is a highly aggressive malignancy for which radical cystectomy (RC) remains the standard treatment. While RC provides effective oncologic control, it significantly impairs patients’ quality of life. As a result, there is growing interest in bladder-sparing strategies. Among these, trimodal therapy (TMT) remains the most established approach, and evolving regimens incorporating novel immune checkpoint inhibitors have expanded therapeutic possibilities. However, a standardized treatment protocol has yet to be defined. Objective: This review outlines the current status and recent advances in bladder-sparing treatments for MIBC, with a focus on treatment principles, established modalities such as TMT, and emerging immunotherapy-based strategies. Conclusion: TMT offers a well-tolerated and potentially curative alternative to RC for select patients with localized MIBC. Its success relies on appropriate patient selection and multidisciplinary collaboration. Immunotherapy-based bladder preservation approaches have shown promising outcomes but require further validation in large-scale randomized clinical trials.

Keywords
Bladder preservation
Bladder-sparing treatment
Immunotherapy
Multimodal therapy
Muscle-invasive bladder cancer
Trimodal therapy
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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