Background: Bladder cancer is a common health problem is Egypt where it is the 3rd common cancer (6.9%) in both sexes and the 2nd common (10.7%) among males. Neoadjuvant chemotherapy has proven benefits in treatment of muscle invasive bladder cancer (MIBC), yet it is still underutilized. Aim: To study the response to neoadjuvant chemotherapy in patients with MIBC and their attitude towards definitive treatment after completion of neoadjuvant therapy. Methods: In this prospective study, 85 patients with MIBC were recruited between September 2013 and September 2014. They were scheduled to receive three cycles of gemcitabine (1000 mg/m2, on days 1 and 8) plus cisplatin (75 mg/m2 on day 1) or carboplatin (AUC=5 on day 1) in patients with impaired renal function prior to definitive treatment. Results: Sixty-seven patients were evaluable for response and toxicity. The majority (79%) were males and their median age was 61 years (range: 38-84). The initial T stage was T3 or T4 in 72% of patients. Complete response was documented in 6 (9%) patients, partial response in 41 (61.2%), stationary disease in 5 (7.5%) and progressive disease in 15 (22.4%). Grade III and IV toxicities were infrequent (5%) with no chemotherapy-related mortality. After completion of the treatment, 9 (13.4%) patients were shifted to bladder preservation treatment due to complete radiological response and refusal of surgery. Conclusion: Neoadjuvant chemotherapy is feasible in MIBC patients in our setting as it gives good clinical response. If offered in a proper way, it doesn't preclude the patients' chances for definitive treatment.