Following the guidelines is the easiest and safest of all, but life is not easy.

Small cell carcinoma of the urinary bladder is a rare entity. Is this cancer different from other forms of transitional cell carcinomas? Do we have special recommendations for patients suffering from small cell carcinoma of the urinary bladder? Yes we do! It is a very aggressive histological type of cancer that develops within the urinary bladder [1]. This type of cancer requires initial neoadjuvantchemotherapy supplemented with radical cystectomy [2].

Following recommendations is a nice and elegant way tomanage patients. Thanks to these recommendations, the doctor can be sure that the chosen decision is the best and safest one for the patient, but we have to remember that the patient is the decision–maker in the process of their treatment. What should we do if the patient does not accept the doctor's suggestions? Do we refuse the treatment?

As doctors, we have to serve our patients. We have to assess the risks for both the patient and ourselves, and try to help anyway. Starownik and colleagues decided to take a risk. They performed partial cystectomy without any additional treatment demanded from the patient [3]. On the other hand, we can find similar cases in literature [4]. The only suggestion now is to follow the patient very carefully.