A 41-year-old white woman first noted painless hematuria at the age of 16. However, evaluation did not include cystoscopy until 7 years prior to admission, at which time a 3.5 cm diameter grade 11, noninfiltrating bladder carcinoma was noted near the right ureteral orifice. There was no known occupational exposure to carcinogens and the patient did not smoke. Over the ensuing 3 years, multiple grade 1-11 papillary lesions were resected and/or fulgurated. After delivering a full-term baby, the patient was begun on a course of intravesical thiotepa 30 mg weekly for four doses and then once a month maintenance. She experienced an excellent response to this treatment without evidence of recurrent bladder cancer for greater than 1 year. However, after about two years it became clear that thiotepa was no longer effective. Subsequently, she was sequentially treated with intravesical mitomycin C 40 mg every week for eight treatments followed by monthly maintenance, BCG 60 mg weekly for six cycles, and finally doxorubicin 60 mg every 3 weeks without apparent effect. At this point, the patient finally consented to radical cystectomy and formation of an ileo-conduit. The histologic appearance of the bladder demonstrated marked inflammation, fibrosis, and ulceration. There was no evidence of residual tumor. She tolerated this well and has continued to do well 1 year after surgery.