<p>Urothelial carcinoma is a common malignancy of the urinary tract and occurs predominantly in elderly men. Although surgery, chemotherapy, and radiotherapy remain the main treatment options, their efficacy in advanced disease is often limited, particularly in elderly patients with comorbidities or poor surgical tolerance. Antibody-drug conjugates (ADCs) combined with immune checkpoint inhibitors have recently emerged as a promising therapeutic strategy. We report the case of a 79-year-old man with advanced urothelial carcinoma who declined radical cystectomy and received disitamab vedotin plus toripalimab. Histopathological examination confirmed high-grade muscle-invasive urothelial carcinoma, and supplementary immunohistochemistry showed HER2 expression of 1+. FISH/ISH and PD-L1 testing were not performed. The patient received treatment every 3 weeks over 2 consecutive days, with disitamab vedotin on day 1 and toripalimab on day 2. After 6 cycles, imaging showed marked tumor regression, and repeat transurethral resection of the tumor bed revealed no residual tumor cells, consistent with pathological complete response. The treatment was generally well tolerated, with only mild fatigue and nausea. This case suggests that disitamab vedotin combined with toripalimab may have activity in selected patients with advanced urothelial carcinoma, including those with low HER2 expression. However, the findings should be interpreted cautiously, and further studies are needed to clarify the role of this regimen and the value of predictive biomarkers. </p>