The influence of systemic chemotherapy on advanced bladder carcinoma is limited. Apparently patients do not benefit from cytostatic treatment prior to surgical removal of the bladder (neoadjuvant chemotherapy). Combination chemotherapy subsequent to radical cystectomy is currently being investigated in several clinical trials, at present, however, adjuvant chemotherapy cannot be regarded as standard treatment. In metastatic disease responses following application of cisplatin and methotrexate were observed in approximately 50% of the patients without significantly influencing cure. Regarding the progress in surgical techniques including continent urinary diversion, improvement of chemotherapy through basic research and development of new cytotoxic agents and novel combination regimens is mandatory.