Although radical cystectomy remains the standard of care for muscle-invasive bladder cancer, many groups are exploring the use of trimodality therapy, including transurethral resection of the bladder tumor (TURBT), radiation, and chemotherapy. With these programs, cystectomy has been reserved for patients with incomplete response or local relapse after combined modality treatment (CMT). Five-year survival rates in the range of 50–60% have been published in these series, and approximately three quarters of the surviving patients maintained their own, well-functioning bladder. Thus, CMT with selective organ preservation has become a reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage and unifocal tumors, in which a complete TUR (R0 resection) is accomplished.