Introduction: There have been only few data published reporting the clinical or pathological features of bladder cancer in Tunisia. Muscle invasive bladder is characterized by poor outcome despite systemic therapy. We aim to report the epidemiological, clinicopathological features and treatment of invasive bladder cancer in a Tunisian population. Materials and methods: A total of 141 patients diagnosed with invasive bladder cancer were included in the analysis. Data were collected and correlated with overall survival (OS). Kaplan Meier survival analysis was used to evaluate the median survival time and survivals were compared by the log-rank test. Results: Median age at diagnosis was 63 years old. Sex ratio was 14.6. Median follow-up duration was 22 months. Smoking was the most important risk factor in our series (81.6%) of cases followed by occupational exposure. Hematuria was the most common symptom reported in 93.6% of cases. Urothelial bladder carcinoma was the most common histologic subtype representing 93.5% of cases. Only 61 patients underwent curative surgery, followed by adjuvant gemcitabine-based chemotherapy in 32 cases. TNM staging was the most significant prognostic factor in our population (p<0.001). Median overall survival of the organ confined group was 60 months, in the locally advanced group was 36 months and in the metastatic group was 12 months (p<0.001). Conclusions: The increasing incidence of bladder cancer is due to ongoing high prevalence of smoking, which represents the main risk factor. Therefore primary prevention is crucial. Bladder cancer remains diagnosed in Tunisia at locally advanced and/or metastatic stages impairing the prognosis.