Bladder cancer is one the top ten most common cancer types in the world, with approximately 550,000 new cases annually . It is expensive to diagnose, treat, and monitor Bladder cancer . Evidences indicates that non-invasive urine-based tests can improve the diagnosis, treatment and monitoring of patients, improving results and reducing costs  Biomarkers such as ImmunoCyt/uCyt+, UroVysion, NMP-22, bladder tumor antigen, CxBladder, and Xpert Bladder Cancer are available. Not many biomarkers have high sensitivity and specificity. However, Cytology has high specificity but not good enough sensitivity . Fourteen studies showed a diagnostic accuracy of 72% sensitivity and 83% specificity of the UroVysion kit. Many studies showed that the UroVysion has higher sensitivity than urine cytology. However, most other studies have demonstrated that UroVysion has lower specificity than urine cytology [3-7]. UroVysion (Abbott Molecular, Inc., Illinois, USA) is based on multicolor fluorescence in situ hybridization (FISH). It has been used in the USA following its FDA approval in 2001. In Japan it was approved in 2017 . Cystoscopy and urine cytology are used to detect bladder cancer in Japan, A Japanese study concluded that UroVysion FISH alone is insufficient to detect bladder cancer and that cystoscopy is essential for the detection or follow up of bladder cancer cases. They found that combined urine cytology and UroVysion FISH detected 40% of urothelial carcinoma cases, but 60% of the cases were not detected. The use of combined UroVysion FISH and urine cytology is considered a reasonable procedure for the detection of non muscle invasive bladder carcinoma .