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Introduction: Neoadjuvant chemotherapy (NC) with MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) improves survival in muscle invasive urothelial cancer (MI-UC) with patients who achieve pathologic complete response (PCR) following radical cystectomy (RC). Gemcitabine/Cisplatin (GC) NC is increasingly employed due to lower toxicity, however, its effectiveness as neoadjuvant therapy is controversial. We describe pathologic and clinical outcomes following NC and RC. Methods: We retrospectively evaluated patients with MI-UC who received NC between 2003 and 2011 (n=37). Those who were treated with neoadjuvant radiation therapy (n= 15) were excluded. We compared initial clinical stage at surgery to final pathological stage and assessed overall-median progression free-survival. Results: Twenty-two patients who received NC were included. Seventeen patients (77.3%) were treated with GC, 3 (13.6%) with MVAC, and 2 (9.1%) with other regimens. The mean time from start of NC to RC was 108 days (SD 94). 10 (59%) patients treated with GC achieved PCR (pT0) from clinical stage T2 (n=5), cT3 (n=2) and cT4 (n=3), and 3 (18%) were downstaged to pTIS from cT2. Two patients treated with MVAC were downstaged to pT1. Mean metastasis-free survival was 14 months (SD 0.8). At a mean post-operative follow-up of 24 months (range 2-71, SD 22), 15 (68%) of patients were disease free. 14 of these patients had received GC. Conclusions: Neoadjuvant GC for MI-UC was associated with a 59% PCR rate at RC and was well tolerated. These data compare favorably with published data on GC and MVAC as NC, and warrant further study.