Bladder cancer (BC) is generally divided into non-muscle-invasive BC (NMIBC) and 
muscle-invasive BC (MIBC). The standard treatment protocol for MIBC patients is 
radical cystectomy preceded by neoadjuvant chemotherapy (NAC). About one-half of 
the MIBC patients show a priori resistance to chemotherapy, and are therefore 
exposed to the risks of disease progression and toxicity from ineffective NAC. 
The discovery of microRNA (miRNA) regulation in tumorigenesis has provided new 
directions for the development of a new type of BC biomarkers. In this review, 
we describe the emerging miRNAs as BC biomarkers for different purposes, 
including diagnosis, prognosis and therapeutic response. miRNA expression 
profile changes with alteration of the tissue phenotype. This phenomenon is 
utilized to predict tumor diagnosis, cancer subclass, disease stage, prognosis 
and therapeutic response. We classified the miRNAs which are involved in bladder 
cancer according to malignant potential, chemoresistance, discrimination between 
normal to cancerous and clinical outcome. Focusing on the major obstacle 
regarding MIBC patient's NAC response, we summarized the miRNAs that are 
deregulated and have the potential to identify the patients resistant to NAC, 
such as miR-34, miR-100, miR-146b and miR-9 and miR-193a-3p. In conclusion, 
miRNAs expression profile of bladder cancer patient is a promising tool that can 
serve as biomarker for different aims. Based on this profile we propose upfront 
radical cystectomy instead of standard NAC to those MIBC patients who are at 
higher risk for chemoresistance and poor response.