Objectives. The relationship between perineural invasion and prognosis has been demonstrated to be poor in a number of malignancies. This has not been evaluated in the bladder. We performed a study to determine the occurrence of nodal metastases, extranodal metastases, and disease-free survival in patients with perineural invasion (PNI) and/or angiolymphatic invasion (ALI) in transitional cell carcinoma of the bladder (TCCB) from radical cystectomy specimens. Methods. A retrospective review of 27 patients treated with radical cystectomy for TCCB was conducted. Comparisons were performed between three groups: PNI with or without ALl (PNI ± ALI, 12 patients), ALl alone (8 patients), and a control group (no PNI or ALl) (7 patients). Results. The mean patient age was 70 years (range 49 to 83). The overall median follow-up period was 11 months (range 1 to 32). PNI ± ALl was predominantly found in Stage T3b disease (14 of 20 [70%] cases). The overall 1 -year disease-free survival was 48%, 67%, and 83% for the PNI ± ALl, ALI alone, and control groups, respectively. Nodal metastases (for all stages combined) were found in 6 of 12 (50%), 3 of 8 (38%), and 1 of 7 (14%) patients in the PNI ± ALl, ALI alone, and control groups, respectively. Similarly, extranodal metastatic disease was found in 5 of 12 (42%), 4 of 8 (50%), and 1 of 7 (14%) patients in the PNI ± ALI, ALI alone, and control groups, respectively. The percentage of deaths for the PNI ± ALI, ALI only, and control groups were 33%, 50%, and 14%, respectively. Conclusions. In TCCB, perineural invasion with or without angiolymphatic invasion and angiolymphatic invasion alone are associated with a higher incidence of nodal and extranodal metastases and death.