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We performed a retrospective survival analysis of 38 patients with small-cell carcinoma of the bladder treated at our institution. In multivariable adjusted analysis, we could not find any significant survival advantage associated with neoadjuvant chemotherapy, surgery, or radiation. Most of the long-term survivors received platinum-based neoadjuvant chemotherapy followed by radical cystectomy.Small-cell carcinoma of the bladder is a poorly differentiated neoplasm with aggressive behavior. We analyzed clinical outcomes of patients who were treated at our institution to identify an optimal treatment strategy.Retrospective chart analysis was performed for patients who were treated for small-cell carcinoma of the bladder at Fox Chase Cancer Center between 1995 and 2015. Survival was compared between different treatment periods (before January 2010 vs. after January 2010) and different treatment modalities (surgery vs. neoadjuvant chemotherapy vs. radiation).Thirty-eight patients were treated for small-cell carcinoma of the bladder at our institution during the 20-year study period. Median survival was 11.8 months and overall survival rates after 1, 3, and 5 years were 46.6%, 26.2%, and 14%, respectively. Survival analysis adjusted for age, histology, and stage showed that no single treatment strategy was significantly superior (95% confidence interval [CI], 0.26-3.03; P = .860 for surgery; 95% CI, 0.31-2.87; P = .928 for neoadjuvant chemotherapy; 95% CI, 0.65-5.49; P = .238 for radiation). In separate analyses of long-term survivors, we found that most received platinum-based neoadjuvant chemotherapy followed by radical cystectomy. Among the 20 patients who received neoadjuvant chemotherapy, downstaging occurred in 9 (45%).Although none of the treatment options were found to be significantly superior with respect to survival, neoadjuvant chemotherapy might halt the progression of the disease until cystectomy and lead to downstaging. At our institution, the best outcomes were observed in patients who received neoadjuvant platinum-based chemotherapy combined with radical cystectomy.