Objective To explore the prognostic value of preoperative serum pre-albumin in the patients with bladder urothelial carcinoma. Methods A retrospective study was conducted on the clinicopathological data of 320 patients with bladder urothelial carcinoma, who underwent radical cystectomy in Changhai Hospital of Navy Medical University (Second Military Medical University) between Jan. 2006 and Dec. 2014. Receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of preoperative serum pre-albumin level. χ² test was used to analyze the relationship between preoperative serum pre-albumin level and clinicopathological characteristics. Log-rank test and Kaplan-Meier method were used to analyze the relationship between preoperative serum pre-albumin level and overall survival and relapse-free survival of the patients. Cox proportional hazards model was used to explore the risk factors of prognosis of the patients. Results Based on optimal cut-off value of 249.5 mg/L, the patients were divided into high pre-albumin (≥ 249.5 mg/L) group (162 cases) and low pre-albumin (<249.5 mg/L) group (158 cases). Compared with the patients in the high pre-albumin group, those in the low pre-albumin group were older and more prone to preoperative hydronephrosis, high pathological T staging, high grade classification, distant metastasis and intraoperative transfusion, and the differences were significant (all P<0.05). The patients in the low pre-albumin group had significantly shorter overall survival and relapse-free survival compared with the patients in the high pre-albumin group (both P<0.05). The results of multivariate Cox regression analysis demonstrated that high pathological T staging, lymphatic metastasis, distant metastasis, intraoperative transfusion and low pre-albumin level were independent risk factors for the overall survival (all P<0.05), and high pathological T staging, lymphatic metastasis, distant metastasis and low pre-albumin level were independent risk factors for the relapse-free survival (all P<0.05). Conclusion Low preoperative serum pre-albumin level is an independent prognostic risk factor for the patients with bladder urothelial carcinoma, and preoperative serum pre-albumin can be used as a common indicator for prognosis of bladder urothelial carcinoma patients.