Recent advances in molecular and cell biology have led to a greater understanding of the basic biology of bladder cancer. However, despite these advances, surgery remains a key component of modern bladder cancer treatment. Endoscopy is the mainstay of the diagnosis and treatment of superficial bladder cancer. Adjuvant intravesical therapy is recommended for patients with high-risk superficial bladder cancer (Ta/T1 high grade). Select patients with invasive bladder cancer (T2/T3) are candidates for bladder-sparing approaches, incorporating transurethral resection of bladder tumor (TURBT), radiation and chemotherapy. The results and complications of endoscopic therapy are discussed. The role of partial cystectomy, radical cystoprostatectomy, prostate-sparing cystectomy, laparoscopic radical cystectomy, lymphadenectomy and urethrectomy in invasive bladder cancer are discussed. The tumor control outcomes and complications of radical cystoprostatectomy (still the gold standard) for organ-confined and node-positive bladder cancer are reported. Surgery remains an integral part of the management of patients with bladder cancer. Improved understanding of the biology of bladder cancer, combined with better surgical techniques and safety, continues to improve the survival and quality of life of patients with bladder cancer.