Background: Tobacco consumption is a well-established risk factor for genitourinary cancers like urothelial and renal cell. This study aims to examine mortality trends associated with tobacco use in these cancer types, both globally and within the U.S., over the period of 1990 to 2019. Methods: Data from the Global Burden of Disease database, based on the International Classification of Diseases versions 10 and 9, were utilized to extract mortality statistics for bladder cancer (BC) and kidney cancer (KC). Age-standardized death rates (ASDRs) for the overall population, as well as Tobacco Attributable Mortality (TAM) were collected by sex and year. TAM was calculated by applying population attributable fraction to cause-specific deaths and disability-adjusted life years by year, location, age group and sex. The database also provided Annual Percentage Change (APC) data. Trends were analyzed using Joinpoint regression. Results: Smoking rates as well as mortality due to tobacco consumption have steadily decreased for both cancers in both sexes globally as well as in the U.S. during the study period. Globally, ASDRs exhibited a decreasing trend for BC and KC, and for both sexes, excluding an increase in ASDR for KC in males (+0.2). In the U.S. ASDR decreased for KC but not for BC in males (Table 1). BC demonstrated the highest proportion of tobacco-induced mortality among the three cancer types, with a nearly 50% contribution globally among males in 1990 that reduced to 39% in 2019. Overall, the tobacco-induced ASDR for kidney cancer in males remained relatively constant globally. Despite reductions over three decades, BC still exhibited a high proportion of mortality attributed to tobacco, particularly among males (39% globally; 31% in the U.S.). In 2019, the U.S. continued to experience higher tobacco-induced mortality rates among females for both KC (17.1 vs. 8.8%) and BC (26.9 vs. 14.3%) compared to the global average. Conclusions: Despite the multiple advances in cancer treatment in the last decades, TAM remains minimally unchanged. While there has been a general reduction in smoking rates overall, a substantial burden persists for tobacco-related malignancies—particularly for BC and KC. These findings underscore the need for heightened awareness and more robust tobacco control policies both globally and within the U.S.