Background: The most prevalent malignancy affect the urinary system is bladder cancer which exhibits a markedly high recurrence rate. The level of urinary microRNA-146a (miR-146a) was significantly higher in superficial bladder cancer patients, and were decreased to normal range after transurethral resection of the bladder tumor (TUR-BT). Its level was increased again if there is recurrence of the superficial bladder tumor diagnosed by follow up cystoscopy. miR-146 may be a clinically important marker for diagnosis and recurrence of superficial bladder cancer and is used instead of follow up operations as follow up cystoscopy for follow up of recurrence . Objective: our work aims to detect a simple, reliable and noninvasive diagnostic and surveillance methods for follow up of superficial bladder cancer. Methodology: The level of miR-146a in urine of 30 superficial bladder cancer patients was evaluated by quantitative reverse transcription polymerase chain reaction assay using voided urine samples before, after TUR-BT and after 3, 6,9,12 months of resection and compared with the result of follow up cystoscopy. Results: miR-146a was significantly increased in urine samples from patients with superficial cancer bladder than in those from the normal individuals (P <.000). Elevated urinary miR-146a levels in patients with bladder cancer were lowered to the normal level after TUR-BT and increased again in those who have tumor recurrence and remain in a normal level in those who have no recurrence after follow up for 3 ,6, 9,12 months after surgery(P=. 007, P=.000 respectively).Conclusion: Our study concluded that urinary miR-146a may be useful as a novel noninvasive diagnostic and follow up marker, anticancer agent or therapeutic target for superficial cancer bladder, also for increasing our knowledge of cancer biology.