Up to now radical cystectomy with or without ancillary methods (radiotherapy, chemotherapy) has been usually considered as the most efficient treatment for invasive bladder cancer. Bladder replacement, which maintains body image, made this mutilation more acceptable for the patient and more easily offered for early stages T1b, T2. According to the progresses of oncologic knowledge, chemotherapy, immunotherapy, it seems reasonable to think that within less than 10 years, conservative treatments for bladder cancer will probably make obsolete radical cystectomy and, of course, associated bladder replacement. Nevertheless, bladder substitution must remain available as a second treatment of choice for some cases and also for bladder deteriorations secondary to trauma, neurologic or benign diseases.