Bladder cancers most commonly do not invade into the wall of the bladder. However, a subset of patients will have tumors that are no longer confined to the superficial lining of the bladder. Surgical management is required when such tumors have invaded into the muscle or fatty tissue around the bladder. In men, the standard surgical procedure is termed “radical cystoprostatectomy.” This implies that the bladder, prostate, and pelvic lymph nodes are all removed. In women with bladder tumors that invade into the wall of the bladder, the standard surgical procedure is termed “radical cystectomy” or “anterior pelvic exenteration.” These terms imply that the bladder, uterus, fallopian tubes, ovaries, cervix, anterior vaginal wall, and urethra are removed along with the pelvic lymph nodes. Because the bladder is no longer present as a urine reservoir, the urine must be diverted either out of the body or into a newly constructed reservoir. The hospital stay is generally five to seven days and patients usually return to work or daily activities in four to six weeks. Some patients have tumors that may benefit from chemotherapy before surgery while other patients require chemotherapy after surgery. Radiation therapy alone is generally thought to be unsuccessful and is reserved only for bladder cancers that can not be treated with surgery.