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Bladder cancer ranks as the ninth most prevalent malignancy worldwide and takes the lead in the incidence of urinary system malignant tumors. This disease tends to affect the elderly population, with the peak onset age at 60, and men face a markedly higher risk of developing the disease than women. Characterized by high recurrence and progression rates, bladder cancer leads to distant tumor metastasis in nearly half of patients, which constitutes the primary cause of death among individuals with advanced bladder cancer. Tumor heterogeneity acts as the core contributor to inconsistent clinical therapeutic outcomes, and patients exhibit dramatically variable responses to standardized treatment regimens. Conventional tumor cell lines are derived from patients’ primary tumor tissues and can reflect the features of tumor gene mutations at the cellular level. Widely used bladder cancer cell lines such as T24, 5637 and J82 are easy to obtain and convenient to culture, yet they suffer from limited diversity of cell subtypes. During long-term serial passaging, cell lines are prone to phenotypic shift, making them incapable of accurately recapitulating the authentic pathological features of primary tumors and fully restoring the inherent heterogeneity of tumors. Patient-derived xenograft (PDX) models are established by implanting human tumor tissues into immunodeficient mice. These models can preserve the heterogeneity and complex biological traits of primary tumors to a certain extent, serving as favorable preclinical models for bladder cancer research. Nevertheless, PDX models have evident drawbacks: complicated operational procedures, excessive experimental costs, incompatibility with high-throughput drug screening, and the inability to simulate the regulatory effects of the human immune system on tumor growth and drug responses. Besides, the construction of PDX models for drug screening generally takes several months, resulting in extremely low experimental efficiency. Patient-derived bladder cancer organoids (BCa PDOs) represent an innovative and groundbreaking technical system in oncology research. They can faithfully recapitulate the tissue architecture and biological functions of human bladder cancer, offering an ideal research vehicle for individualized exploration of tumor heterogeneity, drug sensitivity and the mechanisms underlying drug resistance. Making up for the deficiencies of conventional experimental models, this system bridges the translational gap between basic research and clinical practice and provides novel support for the advancement of individualized precision medicine for bladder cancer.