Micropapillary urothelial carcinoma is a relatively rare neoplasm comprising 0.6-6% of all urothelial carcinomas. Given its rarity, the evidence is scarce regarding the efficacy of neoadjuvant chemotherapy before radical cystectomy which is the cornerstone of treatment in conventional urothelial carcinoma. Historically, micropapillary has been considered to be more aggressive than conventional urothelial, presenting at advanced stage, as well as associated with worse survival outcomes, based on data from observational studies. Further, the role of neoadjuvant chemotherapy has not been well defined in that setting. In our study, we aimed to investigate patterns of pathologic response to neoadjuvant chemotherapy in a cohort of 46 patients diagnosed with micropapillary urothelial carcinoma, as well as their outcomes in comparison with a cohort of 457 patients with conventional urothelial carcinoma. In addition, we presented epidemiologic, clinicopathologic, and survival data from SEER-Medicare database for a cohort of patients with micropapillary carcinoma. Patients in all cohorts underwent radical cystectomy.