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Simple Summary: Metastatic bladder carcinoma is a cancer with a poor prognosis, for which treatments have remained the same for several decades. Immunotherapy has revolutionized the management of several solid cancers, significantly improving the prognosis of some patients. Several protocols have been evaluated this treatment in bladder cancer, in first or second line, with conflicting results. However, two recent studies evaluating immunotherapy either with cisplatin-based chemotherapy or with enfortumab vedotin, an antibody-drug conjugated (ADC), have demonstrated their benefits in terms of overall survival as a first-line treatment, thus redefining the standard of care for patients. Immunotherapy is also being evaluated in the peri-operative setting, with encouraging results for patients with localized or locally advanced bladder cancer. In the past decade, the therapeutic arsenal for metastatic bladder cancer has expanded considerably, with the development of immune checkpoint inhibitors (ICIs), antibody–drug conjugates such as enfortumab vedotin, and anti-fibroblast growth factor receptor agents. Clinical trials evaluating ICIs as neoadjuvants, adjuvants, or first- or second-line treatments have produced conflicting results. However, first-line therapeutic strategies have been redefined by the recent publication of results from two clinical trials: CheckMate-901, which demonstrated the superiority of combined treatment with nivolumab and chemotherapy in extending overall survival, and EV-302, which demonstrated that combined treatment with pembrolizumab and enfortumab vedotin reduced the risk of death by 53%. In this review, we discuss the role of ICIs, alone or in combination, in bladder cancer management in the metastatic and adjuvant settings in 2024, considering the latest published trials. The potential role of ICIs as neoadjuvants is also discussed. [ABSTRACT FROM AUTHOR]