We initiated a prospective phase II trial to assess the outcome of complete surgical removal of metastases from bladder cancer with regard to survival and quality of life. Between 1995 and 1999, 70 patients (52 males, 18 females) with a median age of 64 years (range: 30-88 years) were treated with surgical complete resection of bladder cancer metastases. Patients with asymptomatic (n = 19) and symptomatic (n = 51) secondary metastases from bladder cancer refractory to methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) therapy were included. We removed secondary metastases in lymph nodes (63%), peritoneum (10%), skin (3%), bone (3%), lung (15%), and liver (6%) and measured survival and performance scores. The median survival time was 7 months. With a 1-year survival rate of 30% and a 2-year survival rate of 19%, the prognosis is unfavorable independent from the site of metastasis. However, 83% (42 of 51) of the patients with symptomatic secondary metastases did benefit from surgery regarding quality of life, e.g., performance score, and we assessed an improvement in the WHO performance score from 3.3 to 2.1 (p = 0.005). Surgical removal of metastases from bladder cancer refractory to systemic therapy has an impact on quality of life limited to patients with symptomatic disease.