Background: bladder cancer (BC) is a life menacing disease that harvested a considerable number of deaths anniversary. Noteworthy, BC is the most predominant cancer among Egyptian men with a prevalence rate of more than 15% resulting in 8,000 deaths yearly. Aim of the work: this study was implemented to retrieve which modality (Radical cystectomy (RC) vs bladder-sparing therapy (BST)) had the superiority in the management of patients with muscle-invasive bladder cancer (MIBC). Methods: we performed a retrospective, case-control study from the archived files at the Urology Department in coordination with the Surgical Oncology Unit and Clinical Oncology Department at Bab-Elsharya and Al-Hussein University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo between January 2007 and October 2013. Patients with MIBC, Stage II (T2a-T2b, N0, M0) or Stage III (T3a-T4a, N0, M0), and suitable for chemoradiation and surgery were enrolled in this study. Results: this study comprehended an overall 148 candidates diagnosed with MIBC. Of them, 95 participants were submitted to RC, whilst 53 patients were subordinated to BST. The overall 5-year survival rate was 58.9% and 39.6 % in RC and BST groups, respectively (log-rank test, P= 0.273). Additionally, disease-free survival rates were 86.8% in patients subjected to BST and 91.6% in patients subjected to RC (log-rank test, p= 0.6). Conclusion: despite no differences were established between RC and BST regarding overall survival rate and disease-free survival rate, BST is an emerging procedure with considerable low complications relative to RC