Muscle-invasive bladder cancer (MIBC) is a challenging disease with specific management and treatment. The diagnosis of this disease is based on the pathology from a transurethral resection, and the morphology of the tissue can predict the behaviour of the tumour. Thus, it is important to follow a systematic description of the clinical and pathological findings. The current gold-standard techniques to stage MIBC is computed tomography (CT) scan and magnetic resonance imaging (MRI). The local stage, nodal involvement and metastatic spread should all be studied. The treatment of choice for localized MIBC in fit patients consists of a radical cystectomy (RC) with a pelvic lymph node (LN) dissection. In some cases, neoadjuvant or adjuvant cisplatin-based chemotherapy should be considered. For selected patients, multimodal approaches, including transurethral resection of bladder tumour (TURB), radiation therapy and chemotherapy, should be considered as curative options. For those patients unfit to undergo aggressive curative treatment, palliative care should be carefully planned. Metastatic disease should be treated with cisplatin-based chemotherapy when possible. Unfit patients should be offered checkpoint inhibitor immunotherapy or carboplatin-based chemotherapy. Once treated, patients with MIBC should be closely followed up mainly with urography CT scan.