Objective To explore the effect of hypoxia on postoperative prognosis of radical cystectomy in patients with bladder cancer. Methods A total of 66 patients with bladder urothelial cancer undergoing radical cystectomy surgery were divided into hypoxia group (OH group, n=19) and the normoxic group (NS group, n=47). Immunohistochemical examination was used to examine the expression of HIF-1α and CD105-assessed microvessel density (MVD). The survival of the patients was followed up and the clinical data of the two groups were compared. Kaplan-Meier analysis was used for analyzing the survival of the two groups, and a Cox model was established to analyze correlation of each variable with the survival time. Results In the OH group, the positive rate of HIF-1α was 89.5% (17/19) in the tumor tissues, the MVD value was 53.1±19.0, and the median survival time was 56 months; the corresponding values in the NS group were 66.0% (31/47), 40.1±15.2, and 82 months, respectively. The clinical stages, Hb levels, HIF-1α expression, and MVD values were significantly different between the two groups (P＜0.05). Advanced tumor stage, hypoxia state，high HIF-1α expression and high MVD value in tumor tissues were associated with a shorter survival of patients, and high Hb was associated with a longer survival of patients (P<0.05 or P<0.01). Conclusion Hypoxic state can lead to increased HIF-1α expression and microvessel density in bladder cancer tissues, which is harmful for patient prognosis.