Background Bladder cancer is a rare entity in young adults, and the course of the disease is not well defined. This study aims to analyze the clinical characteristics, risk factors, disease progression, and survival outcomes of bladder cancer patients aged 40 years or younger. Methods A retrospective review was conducted of 162 young bladder cancer patients treated from August 2017 to May 2024. Recurrence-free survival and overall survival were analyzed using Kaplan-Meier analysis. Results Of the 162 patients, 138 (85.2%) were male, with a mean age of 34.5 years. Key risk factors included tobacco use (80 patients, 49.4%) and occupational exposure to chemicals (50 patients, 30.9%). The predominant histology was urothelial carcinoma (159 patients, 98.1%). Muscle-invasive bladder cancer (MIBC) was observed in 42 patients (26.4%). Among patients with non-muscle-invasive bladder cancer (NMIBC), 61 (53.5%) had high-grade tumors. High-grade tumors and recurrence were frequent, with a mean recurrence-free survival of 3.7 years. Patients with muscle-invasive disease had poorer survival (mean 3.4 years) compared to those with non-muscle-invasive disease (mean 6 years). Conclusion Young bladder cancer patients exhibit a more aggressive disease course than reported in older cohorts. The findings underscore the importance of early detection, targeted treatment strategies, and tailored surveillance in young patients due to their unique risk factors and disease characteristics.