More investigations are required to evaluate the association between H. pylori infection and bladder cancer (BC) aggressiveness. This study aimed to evaluate this association using a comparison of urinary epithelial membrane antigen (EMA) levels between H. pylori infected and non-infected BC patients. Using enzyme linked immunosorbent assay (ELISA), urinary EMA was detected in H. pylori-infected and non-infected BC patients with different tumor outcomes. H. pylori infection was more prevalent in BC (65.3%) patients compared to patients with benign bladder cystitis (33.3%). Elevated urinary EMA levels were associated with BC (3.8±0.3 vs. 1.7±0.1 μg/mL). Among H. pylori infected patients, high concentrations of urinary EMA were also related to BC aggressiveness including MIBC (4.2±0.2 vs. 2.7±0.2 μg/mL; OR=11.5) and high histological grades (4.5±0.3 vs. 2.9±0.2 μg/mL; OR=12.3). In conclusion, elevated urinary EMA in patients infected with H. pylori compared to non-infected BC patients,