[Muscle invasive bladder cancer and bladder preservation protocols. Where are we?]

Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortalityas sociated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates. Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortality associated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates.Bladder preservation has historically been used in 2clinical scenarios: 1) Patients unable to under go a radicalcystectomy due to comorbidities o patients that rejectradical cystectomy, and 2) patients that are offeredbladder preservation strategies with and oncologicalsafety and curative intent.This is the real scenario for bladder preservation, thefirst scenario belongs to palliation, not cure.In the current manuscript, we will review the bladderpreservation strategies for muscle invasive bladdercancer, specially focusing on trimodal therapy (recommendedby international guidelines) and tetramodaltherapy.