Background& Objectives:Bladder cancer is one of the commonest cancers encountered worldwide. There is derth of significant prognostic marker of it. Neutrophil lymphocyte ratio may be a significant prognostic marker of bladder cancer as recent studies have linked it to several malignancies. The present study was intended to evaluate its usefulness in bladder cancer.Methods:A total of 32 patients with bladder cancer were evaluated for Neutrophil to lymphocyte ratio preoperatively from 2016 to 2018 at AIIMS Patna. Patients were followed with postoperative histopathology reports. Trans-urethral resection of bladder tumour was done initially in all the patients. Pathological grade was correlated to the initial Neutrophil lymphocyte ratio.Result:Higher Neutrophil lymphocyte ratio significantly correlated to higher grade of tumour.Conclusion:Preoperative Neutrophil lymphocyte ratio predicts the aggressiveness of bladder cancer.