Numerous investigations are required during the course of diagnosis, staging, and surveillance of bladder neoplasms. Improvements in the clinical maneuvers that have traditionally been performed on bladder cancer patients may facilitate a more precise determination of tumor stage or the presence of recurrence. New techniques for assessing patients hold promise for more accurate diagnosis and follow-up. This article reviews some of the advances in clinical and radiologic investigations for staging and surveillance of bladder cancer patients, including the tumor, node, metastasis (TNM) staging system; protocols for staging bladder cancer and follow-up of patients after treatment; methods of surgical resection and pathologic examination; fluorescence cystoscopy; virtual cystoscopy; positron emission tomography; and ultrasmall superparamagnetic iron oxide magnetic resonance imaging.