Purpose: The COVID-19 pandemic forced oncologists to balance the risk of cancer progression with the immunosuppressive effects of treatment. We assessed if the treatment received by muscle invasive bladder cancer (MIBC) patients during the pandemic was different from the treatment decision discussed in the clinic and how that changed compared to pre- and post-pandemic. Methods: We retrospectively collected data of patients treated for MIBC in our institute from January to June 2020 (first wave of COVID-19). We assessed if the patients’ treatment plans were changed and compared the proportion across similar time periods (January to June) in 2019 and 2021. Change of treatment was defined as premature termination due to any cause, change of agents/modality and omission of planned treatment. Kruskall–Wallis test was used to compare the proportions over the three time periods. Mann–Whitney U-test was used to compare treatment between any two years. Results: In total, 115, 79 and 110 patients were treated for MIBC in 2019, 2020 and 2021, respectively. Treatment received was altered in 30.4%, 32.9% and 20.9% of patients in the corresponding years (P = 0.13). The proportion of patients with chemotherapy changes was significantly different across 2019–2021 (P = 0.01). There was a higher proportion of chemotherapy changes in 2020 (50%) when compared to 2019 (25.5%; P = 0.02) and 2021 (20%; P = 0.009). There was no significant difference between 2019 and 2021 (P = 0.55). No significant difference was noted in the proportion of patients who had altered treatment schedules in terms of radiotherapy (P = 0.10) or use of radiosensitisers (P = 0.71) across all three years. Conclusion: There was a significant impact of the first wave of the pandemic for planned chemotherapy. By January to June 2021, patterns of practice had recovered to those of 2019. The pandemic did not affect radiotherapy and radiosensitisation practice.