<p>Bladder cancer is a prevalent global urological malignancy characterized by significant gender differences in incidence and prognosis, ranging from indolent non-muscle invasive bladder cancer with high recurrence rates to lethal muscle invasive subtypes accompanied by distant metastasis and poor survival outcomes. Despite advances in molecular biology and therapy, the treatment options for bladder cancer remain limited. Recent advancements have shed light on the promising potential of bladder cancer organoids (BCOs) as a tool to bridge the gap between basic science, clinical therapeutics, and drug development. By modeling tumor heterogeneity, tumor microenvironment (TME) and dynamic responses to treatment, BCOs have emerged as a transformative platform in cancer research. This narrative review systematically discusses the translational potential of BCOs, focusing on their establishment and culture protocols, as well as applications in basic science, clinical therapeutics and drug development. At present, however, the clinical translation of BCOs is still constrained by multiple challenges, including absence of standardized culture protocols, inter-patient biological variability, incomplete reconstruction of the native TME, complex operational procedures and insufficient clinical validation. Addressing these limitations in the future will be critical to fully unlock the clinical potential of BCOs and accelerate their widespread use in translational research.</p>