In this report, we present two male patients with locally advanced rectal cancer whose initial complaints were chiefly urologic symptoms, such as dysuria and hematuria. Due to rare occurrence, they were managed as primary bladder cancer and proper treatments for rectal cancer were delayed. However, the locally advanced rectal cancer involving urinary bladder was successfully treated by anterior resection with partial cystectomy. Even though the patients presented symptoms of primary bladder cancer, it is important to perform initial diagnostic work-up, including careful question about any problems in defecation and digital rectal examination.