The standard of care for muscle-invasive bladder cancer is radical cystectomy with bilateral pelvic lymph node dissection. However, nowadays there is a tendency for organ preservation in selected cases of muscle-invasive bladder cancer. The triple-combined therapy consisting of a transurethral resection followed by concomitant chemoradiotherapy results in comparable outcomes to radical cystectomy. Clinical criteria in determining patients for organ preservation includes: small tumor size (< 2 cm), absence of urethral obstruction, no evidence of pelvis lymph node metastases, and absence of carcinoma in situ. Bladder conservation therapy could be offered to selected patients as one alternative to radical cystectomy.