Muscle-invasive bladder cancer is an important oncological problem. When no distant metastases are detected, a radical cystectomy is the standard treatment. In recent years new developments in the treatment of the disease have been explored. These developments comprise new surgical techniques such as neobladder construction using the patient's intestinal tissue, sexuality-preserving surgery and robot-assisted surgery. Furthermore, indications for perioperative chemotherapy are discussed. Finally, bladder-sparing approaches are described: brachytherapy and chemo-radiation.