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In the last few years, angiogenesis has confirmed its critical role in the development of malignant neoplasms. Antiangiogenic drugs, mainly bevacizumab, sorafenib, or sunitinib, are currently approved in a wide number of tumor types, such as breast, colorectal, liver, or kidney cancer, and have changed dramatically the evolution of our patients. Unfortunately, in urothelial carcinoma, which is a very common neoplasm, antiangiogenic agents are still in a very preliminary phase of clinical research. In this study, we focus on the biological basis of angiogenesis in urothelial tumors, its influence in the prognosis of these malignancies, and the available evidence about the use of antiangiogenic drugs in urothelial carcinoma.