Muscle-invasive bladder cancer (MIBC) is typically managed with radical cystectomy, supplemented by neoadjuvant chemotherapy to improve survival rates. However, certain patients decline radical cystectomy despite having completed neoadjuvant chemotherapy. Evaluating the treatment outcomes of these individuals is essential to clarify their prognosis and provide evidence-based guidance for optimal clinical decision-making.

This report presents a case in which a patient declined radical cystectomy despite achieving a complete response to neoadjuvant chemotherapy. Following chemotherapy, the patient underwent transurethral resection at the site of the previously resected bladder tumor, with subsequent surveillance every three months involving cystoscopy and contrast-enhanced computed tomography of the urinary tract. In addition, we review the current international literature regarding such cases.

The pathological findings from the TURBT performed following neoadjuvant chemotherapy were negative. Furthermore, quarterly cystoscopic evaluations and contrast-enhanced CT scans of the urinary tract over one year have shown no evidence of bladder tumor recurrence.

Opting out of radical cystectomy after neoadjuvant chemotherapy is not recommended by major urological associations. However, certain studies indicate that not all cases carry a poor prognosis. As medical practice continually evolves, investigating appropriate criteria for omitting radical cystectomy following neoadjuvant therapy—together with advancements and refinements in chemotherapy regimens—offers the potential for successful bladder preservation.