Large numbers of genetic and epigenetic alterations have been identified in bladder cancer in recent years. Many of these affect the function of tumour suppressor genes (TSGs), leading to partial or complete loss of protein expression or function with varied phenotypic consequences. Some of the genes implicated such as TP53 and RB1 are major players in many other tumour types. Others, particularly some on chromosome 9, show bladder-specific involvement. Other TSGs of relevance to bladder tumour development are predicted by the finding of common physical deletion or LOH in specific regions of the genome. This review summarises the approaches that have been used to identify bladder tumour suppressor genes, the current state of knowledge of the genes involved in this disease, their relationship with specific clinical features and some possible therapeutic applications.