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No gross cancer at the surgical margins; microscopic invasive urothelial carcinoma positive margins are allowed; carcinoma in situ (CIS) at margins is considered negative margins;
No evidence of residual cancer or metastasis after surgery; patients with upper tract urothelial carcinoma must have a negative cystoscopy within 3 months prior to pre-registration; if the bladder has been removed a cystoscopy is not required;
No metastatic disease (or radiologic findings "concerning" for metastatic disease) on cross-sectional imaging (according to Response Evaluation Criteria in Solid Tumors [RECIST] version [v]1.1 criteria);
No active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids; these include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma, inflammatory bowel disease (IBD), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome because of the risk of recurrence or exacerbation of disease; human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible;
No current pneumonitis or prior history of non-infectious pneumonitis that required steroids within the previous 5 years
No known active hepatitis B (e.g., hepatitis B surface antigen \[HBsAg\] reactive) or hepatitis C (e.g., hepatitis C virus \[HCV\] ribonucleic acid \[RNA\] \[qualitative\] is detected)
No live vaccine within 30 days prior to the first dose of study drug; examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette-Guerin (BCG), and typhoid vaccine; seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., FluMist) are live attenuated vaccines and are not allowed
No postoperative/adjuvant systemic therapy
No prior treatment with any therapy on the PD-1/PD-L1 axis
No treatment with any other type of investigational agent =\< 4 weeks before pre-registration
No major surgery =\< 4 weeks before pre-registration
No radiation therapy =\< 4 weeks before pre-registration
No neoadjuvant chemotherapy =\< 4 weeks before pre-registration
Not currently requiring hemodialysis
Age \>= 18 years
Not pregnant and not nursing, because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown
ECOG performance status =\< 2
Absolute neutrophil count (ANC) \>= 1,200/mm\^3
Leukocytes \>= 3,000/ mm\^3
Platelet count \>= 75,000/mm\^3
Hemoglobin \>= 9 g/dL or \>= 5.6 mmol/L
Total bilirubin =\< 1.5 x upper limit of normal (ULN)
Bilirubin for patients with Gilbert's =\< 3.0 x ULN
Calculated (calc.) creatinine clearance \>= 30 mL/min (using either Chronic Kidney Disease Epidemiology Collaboration \[CKD-EPI\] equation or Cockcroft-Gault formula)
Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =\< 3.0 x upper limit of normal (ULN)
Serum albumin \>= 2.8 g/dL
For women of childbearing potential only: a negative urine or serum pregnancy test done =\< 7 days prior to pre-registration is required
REGISTRATION ELIGIBILITY CRITERIA: Results of central PD-L1 testing available; Q2 Solutions will forward the PD-L1 results to the statistical center and the statistical center will notify the site that the result is available; since the results with be blinded to the site the notification from the Alliance registration/randomization office will serve as a confirmation of this eligibility criteria; after sites receive the confirmation e-mail from Alliance they can register the patient
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