Small cell urothelial carcinoma is a rare form of bladder cancer for which management is commonly extrapolated from small cell lung carcinoma. The rate of development of brain metastatic disease in patients that present with localized disease is unknown. The purpose of this analysis is primarily to compare the rates of development of brain metastasis between patients initially diagnosed with non-metastatic small cell urothelial carcinoma versus those with high grade transitional cell carcinoma. From 2000-2020, 17 consecutive patients from one institution that had small cell urothelial carcinoma were identified. These patients were compared to a control group comprised of 34 patients with high grade transitional cell carcinoma matched for age at the time of surgery, gender, stage, cystectomy rate, and year of surgery. The overall survival rate at 3 years for patients with small cell urothelial carcinoma compared to high grade transitional cell carcinoma was 34.2% vs 30.8% (p=0.95) with a hazard ratio of 0.96 (95% CI: 0.47-1.94, p=0.90). The disease-free survival rate at 3 years for patients with small cell urothelial carcinoma compared to high grade transitional cell carcinoma was 17.6% vs 14.9% (p=0.95) with a hazard ratio of 1.155 (95% CI: 0.492-2.714, p=0.74). The rate of development of brain metastases was not significantly different from the control group (12% vs 9%, p=0.91). This data suggests that for small cell urothelial carcinoma, screening for and management of brain metastatic disease might more appropriately be extrapolated from transitional cell carcinoma rather than small cell lung carcinoma. Although small cell urothelial carcinoma is known as a rare and very aggressive form of bladder cancer, patient outcomes including the development of brain metastases do not appear to be different than the most common type of high-grade bladder cancer.