Aim: To evaluate the perioperative, pathological, and oncological outcomes of radical cystectomy performed at a single regional Australian centre over a 21-year period and assess whether outcomes align with those reported by higher-volume metropolitan centres. Method: A retrospective review was conducted of all patients who underwent radical cystectomy for primary bladder cancer between January 2002 and December 2023 at a regional centre in New South Wales. Patient demographics, surgical details, pathological findings, and survival outcomes were collected. Kaplan-Meier analysis was used to assess 5-year overall and disease-free survival. Results: A total of 138 patients underwent cystectomy (mean age 67.4 years; 78.3% male). Most received ileal conduit diversion (79.7%), followed by neobladder (19.6%). Final pathology included pT0 (21), pT1 (21), pT2 (39), pT3 (23), and pT4 (20). Lymph node dissection was performed in 98%, with a mean of 22 nodes removed. Positive surgical margins were present in 13.8%. Thirty-day mortality was 3.6% (n=5), due to causes including pulmonary embolism and myocardial infarction. Median length of stay was 11 days. Median follow-up was 44.8 months. Five-year overall survival and disease-free survival were 67% and 69%, respectively. Higher tumour stage correlated with increased mortality and shorter survival. Neoadjuvant chemotherapy was used in 38% of patients, with adjuvant chemotherapy in 9%. Conclusion: Outcomes of radical cystectomy at this regional centre are comparable to those of larger metropolitan centres. Routine pelvic lymph node dissection, structured perioperative care, and growing surgical experience contributed to favourable results. These findings support the delivery of complex urologic oncology care in regional settings.