Objectives Radical cystectomy is a complex surgery for bladder cancer which has undergone progressive changes for a century. The originators of the procedure required pioneering innovation and their biographies place the challenges of radical cystectomy in proper perspective Methods English and German textbooks and secondary sources Results Bernard Bardenheuer (1839-1913) and Karl Pawlik (1849-1914) performed the world’s first two cystectomies for bladder cancer, overcoming challenges of contemporary anesthesia, vascular control, and renal drainage. Conclusions The originators of radical cystectomy illustrate that true advances in surgery require bold innovation and forward thinking but also that the limitations of contemporary technology must be overcome.