The failure of radical cystectomy to cure the majority of patients with muscle invasive transitional cell carcinoma of the bladder has prompted clinical trials evaluating adjuvant chemotherapy. No properly conducted prospective trials are available to support unequivocally the application of pre- or postsurgical chemotherapy. A large trial comparing chemotherapy with no chemotherapy and standard treatment (cystectomy) is nearing completion. The results will determine whether or not adjuvant chemotherapy becomes the standard of care.