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In this review, the authors focus on novel therapeutic and diagnostic approaches in the perioperative setting, with an emphasis on patient\u2010centered and individualized care. For urothelial carcinoma of the bladder (UCB), advances in nonplatinum\u2010based therapies, specifically immunotherapy and antibody\u2013drug conjugates, have expanded the therapeutic arsenal for patients with muscle\u2010invasive UCB in both the neoadjuvant and adjuvant settings to improve survival outcomes. Given the significant morbidity of extirpative surgery (radical cystectomy and urinary diversion), there have also been greater efforts to evaluate bladder\u2010sparing protocols and improve the selection of patients for surgery and their postoperative recovery. The authors review special considerations for organ\u2010sparing surgery in females, geriatric co\u2010management, and enhanced recovery after surgery protocols. For upper tract urothelial carcinoma, there has been increasing recognition of its unique diagnostic and therapeutic challenges, including risks of renal functional loss. There have been advances in molecular profiling that have demonstrated various genomic differences between upper tract urothelial carcinoma and UCB, with treatment implications. This article reviews studies evaluating perioperative care that focused on optimizing therapeutic approaches, including neoadjuvant\/adjuvant chemotherapy and immunotherapy, as well as nephron\u2010sparing strategies in carefully selected cases.<\/jats:p>","DOI":"10.3322\/caac.70019","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T12:35:18Z","timestamp":1749213318000},"page":"528-551","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Urothelial carcinoma: Perioperative considerations from top to bottom"],"prefix":"10.3322","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2389-3046","authenticated-orcid":false,"given":"Wesley","family":"Yip","sequence":"first","affiliation":[{"name":"Division of Urology and Urologic Oncology Department of Surgery City of Hope Comprehensive Cancer Center  Duarte California 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