Abstract Neutrophil to lymphocyte ratio (NLR) is an inflammatory index that have been considered as a potential prognostic factor in human cancer. The aim of the study was to evaluate the available evidence regarding the NLR as a prognostic value in patients affected by urothelial cancer. This literature review included paper on NLR in urothelial cancers was done on PubMed/Medline and Cochrane libraries in November 2015. The selection of the articles followed the PRISMA process. Twenty-three of 99 articles fulfilled all the inclusion criteria, including data on 6240 patients affected by urothelial cancers. Overall and cancer specific survival (OS and CSS) and recurrence free survival (RFS) were evaluated as the main oncological outcomes. There was significant heterogeneity among studies and the majority of studies were of poor quality. Overall NLR was considered as a prognostic marker in 87.5%, 80%, 60% of the studies on Upper Tract Urothelial Cancer (UTUC), Urothelial Bladder Cancer (UBC) and metastatic and advanced disease, respectively. The NLR cut-off value ranged between 2 and 5. A high NLR was associated with worse OS, CSS and RFS. NLR is a widely available, easy-to-collect, costless, prognostic marker in urothelial cancers. Its clinical use still remain under investigation especially for the need of cut-off values, in particular in different subsets of patients.