Background: Real-world treatment patterns and survival outcomes of locally advanced, unresectable, and metastatic urinary tract cancer (mUTC) patients have not previously been studied in a nationwide, population-based cohort. Objective: To describe treatment patterns and survival outcomes in mUTC patients treated in the real-world clinical setting. Design, setting, and participants: This nationwide, population-based study included all mUTC patients initiating first-line chemotherapy at Danish oncology departments from January 2010 to March 2016. Data were retrospectively obtained from electronic medical records. Outcome measurements and statistical analysis: Outcome measurements were descriptive. Kaplan-Meier was used for survival analysis. Results and limitations: Of 952 patients included in the study, 46.2% initiated standard gemcitabine/cisplatin (GC) and 21.1% gemcitabine/carboplatin (CaG); the remaining patients initiated other treatment regimens. Median follow-up was 11.6 mo. The overall response rate and disease control rate were 43.0% and 61.7% in all patients, 51.4% and 69.1% in GC-treated patients, and 34.4% and 58.8% in CaG-treated patients, respectively. Median overall survival (OS) was 11.7 (95% confidence interval [CI]: 10.8–12.5) mo in all patients, 14.0 (95% CI: 12.5–15.5) mo in GC-treated patients, and 9.8 (95% CI: 8.7–10.9) mo in CaG-treated patients. Limitations include the retrospective study design. Conclusions: Real-world mUTC patients are older and less fit than patients enrolled in clinical trials; despite this, tumor responses and survival are comparable. Survival in our patient cohort is also comparable with that reported from other real-world studies in this patient group. Patient summary: We studied treatment patterns and survival in urinary tract cancer patients receiving chemotherapy in the real-world clinical practice. Survival in our patient cohort was comparable with that reported from clinical trials and other real-world studies in this patient group. Most metastatic urothelial tract cancer patients receiving chemotherapy in the real-world clinical setting at Danish oncology departments receive cisplatin-based treatment. Survival in our patient cohort was comparable with the survival reported in clinical trials and in other real-world studies in this patient group.