<p>Bladder cancer organoids (BCOs) represent a sophisticated three-dimensional pathological model that faithfully recapitulates the tissue architecture and molecular subtypes of parental tumors, thereby serving as a robust platform for investigating tumor heterogeneity and phenotypic plasticity. By establishing a functional bridge between pathological features and drug responses, BCOs not only enhance traditional morphological diagnoses but also predict patients’ responses to chemotherapy, targeted therapy, and immunotherapy, thereby guiding individualized treatment strategies. Although BCO models face limitations such as culture bias and the absence of tumor microenvironment, which may impact accuracy, emerging technologies like assembloids and organ-on-a-chip systems are transforming patient-derived tumors from static morphological analysis to an integrated “dynamic pathology”. This evolution ultimately advances precision oncology in bladder cancer.</p>