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Bladder cancer is a heterogeneous disease, both clinically and pathologically. Its detection is still based on methods with low sensitivity and although standard pathological and clinical variables provide important prognostic information, these parameters seem to be insufficient to accurately predict the behavior of these tumors. The relevance of aberrant epigenetic patterns in human neoplasms has surfaced over the last decade, placing epigenetics at the forefront of cancer research. Recently, epigenetic-based biomarkers have brought to light new insights into the clinical management of bladder cancer. A large number of these markers arose in an attempt to better understand the molecular mechanisms involved in bladder carcinogenesis and tumor progression and how these may translate into diagnostic or prognostic tools. The time has come to turn these findings into clinically meaningful biomarkers, capable of detecting tumors through noninvasive approaches, establishing the clinical relevance of each bladder cancer and predicting response to therapy.