OBJECTIVE: Patients with invasive bladder cancer often need radical cystectomy with its implications on quality of life. Bladder preservation combining surgery and radiotherapy could maintain quality of life without compromising tumor control. STUDY DESIGN: Twenty-eight selected patients with different stages of invasive bladder cancer were treated with preoperative external beam radiotherapy in a dosage depending on the tumor stage. Subsequently they underwent surgical exploration with or without partial cystectomy and insertion of source carrier tubes for afterloading with iridium-192. A close follow-up consisted of 3-monthly urine cytology, cystoscopy and yearly CT scan. RESULTS: Sixteen patients (57%) are alive with no evidence of disease. Five patients (18%) have died of non-cancer-related causes without evidence of recurrent tumor. Tumor progression was seen in 7 patients (25%). CONCLUSIONS: Interstitial radiation can result in long-term complete remission in patients with small solitary invasive bladder tumors. The afterloading technique is safe and effective. The selection of patients is the most relevant key to success.