Abstract: Nonmuscle invasive bladder cancer (NMIBC) is mainly composed of three different types of tumors: papillary urothelial carcinoma is limited to the mucosal layer (Ta), high-grade carcinoma in situ is limited to the epithelial layer (CIS) and tumors invading the submucosa or lamina propria (T1). The standard treatment for NMIBC is complete transurethral resection of bladder tumors (TURBT) with or without intravesical instillation therapies. However, some high-risk patients are at risk of tumor progression and therefore require more aggressive treatment. Studies have reported that delayed cystectomy can lead to a significant reduction in survival benefits. Therefore, for these NMIBC patients who are at high risk of disease progression, when to abandon conservative treatment and choose cystectomy is one of the biggest challenges. This article reviews the current application status and future directions of radical cystectomy as the initial treatment on NMIBC patients.