Objectives: To investigate the role of radiotherapy (RT) alone in metastatic spinal cord compression (MSCC) patients with bladder cancer. Methods: Thirty-two MSSC patients with bladder cancer were included in this retrospective review. Potential prognostic factors were investigated for functional outcome, local control of MSCC, and survival: age, gender, performance status, visceral metastases at the time of RT, number of involved vertebrae, ambulatory status, time of developing motor deficits before RT, and radiation schedule (short-course RT [1 week or less] versus long-course RT [2 to 4 weeks]). Results: Two patients (6%) showed improvement of motor function, 25 (78%) no change, and 5 (16%) deterioration. Better functional outcome was significantly associated with a better performance status (P = 0.035). A trend was observed for absence of visceral metastases (P = 0.054). Five patients developed a recurrence of MSCC in the preirradiated spinal region, which was treated with reirradiation (0 improvement, 4 no change, 1 deterioration). Median survival was 4 months. The 1-year survival rate was only 16%. Better survival was associated with absence of visceral metastases, being ambulatory, involvement of only one to three vertebrae, and better performance status. Conclusions: Improvement of motor function was rare. For patients not suitable for decompressive surgery, short-course RT seems preferable because it provides a functional outcome similar to that with long-course RT and is more patient convenient. If the patient's prognosis seems extremely poor in terms of functional outcome and survival, single-fraction RT or even best supportive care may be considered.