In the late 19th century, partial cystectomy was occasionally used for bladder tumours, yet total bladder removal was thought impossible. Two pioneering surgeons, Bernhard Bardenheuer (1839–1913) in Germany and Karel Pawlik (1849–1914) in Prague, challenged this dogma by undertaking the first total cystectomies in 1887 and 1889. Bardenheuer’s operation, performed on a 57-year-old male with advanced bladder cancer obstructing both ureters, using the newly invented cystoscopy for diagnosis. Despite early technical success in excising the bladder and mobilizing the tumour, the patient succumbed to uremia two weeks later. Pawlik’s approach involved a two-stage procedure in a female patient with recurrent malignant papillomas. By first creating ureterovaginal fistulas and then resecting the bladder via an extraperitoneal suprapubic incision, Pawlik constructed an innovative orthotopic neobladder using the vaginal vault. Although complications delayed complete healing, the patient survived and retained partial urinary continence. These initial cystectomies were rudimentary compared to modern “radical” operations, as neither surgeon removed perivesical tissues or lymph nodes. Yet, they demonstrated that total bladder removal was feasible and spurred progress in urologic oncology. Admittedly, these early operations had high morbidity, with urinary diversion representing a major challenge. Nonetheless, their legacy endures in contemporary radical cystectomy and neobladder reconstruction, which rely on oncologic principles not fully appreciated until a century later. Their interventions stand as milestones in surgical history, exemplifying how innovation and courage can reshape clinical practice and improve patient outcomes.