It has been estimated that in 2010, there were more than 70,000 new cases of bladder cancer diagnosed in the United State, with more than 14,000 cancer specific deaths1. While approximately 70-80% present with non muscle invasive disease, 20% of these patients will be refractory or intolerant to intravesical therapies and another 10-30% of these patients will ultimately progress to muscle invasive disease2. For patients with NMICB that progress and the 20-30% that present with organ-confined muscle invasive disease (≥cT2), the bladder cancer NCCN guidelines recommend radical cystoprostatectomy with consideration for neoadjuvant chemotherapy3. Large institutional series from centers of excellence report overall 5 year survival rates ranging from 45-66% with perioperative mortality rates less than or equal to 3%4, 5, and perioperative complication rates ranging from 25-57%5, 6. With surgery alone, stratified by pathologic stage, 5 year survival rates are 66% for pT2 disease, 35% for pT3 disease, and 27% for pT4 disease respectively7.