Approximately 70% to 85% of patients with transitional cell carcinoma of the bladder present with tumors that are confined to the mucosa or submucosa. Recent articles have proposed that these tumors should be classified in one major group and treated in a similar fashion. Although a number of molecular and biologic markers can be used to segregate more aggressive tumors from those with little mortal threat, it is almost impossible to predict the outcome of patients individually. Unless such categorization is available, recommending a more radical or more liberal approach is prone to errors. Current available data suggest that selected cohorts of patients with limited lymph node involvement may benefit from pelvic lymph node dissection with radical cystectomy. To obtain sustained survival advantage, however, more efficacious chemotherapy regimens are needed because sole-dose intensification in the standard protocols will not be sufficient to achieve this goal.