This study was aimed that the evaluation of tissue elasticity for determination of the characterization of bladder masses. The prospective study was performed between May and September 2014. This study included 39 patients who presented with microscopic or gross hematuria and had primary bladder mass and according to ultrasound or computed tomography results. ARFI elastography was performed by one experienced radiologist then, the shear wave velocity was measured. Two measurements were performed on each bladder mass and average values were evaluated. The mean age of patients was 63.9 ± 15.2 and there were 32 male, 7 female patients. The mean diameters of benign and malignant lesions were 1.2 and 4.4 cm, respectively. The mean diameter of bladder mass lesions was 4.87 ± 2.23 cm. Transurethral resection of the tumors and histopathologic examination revealed 26 malignant lesions, whereas 13 patients had benign lesions. The mean shear wave velocity (SWV) value of the malign lesions (3.28 ± 0.74 m/sn) was significantly different from benign lesions 1.7 ± 0.82 (p < 0.01). Our prospective study shows that Acoustic radiation force impulse (ARFI) imaging may be useful for differentiating between benign bladder lesions and malignant bladder tumours. Because ARFI imaging is a non-invasive and low-cost imaging modality, we propose that adding it to conventional sonography may improve accuracy and aid in the differential diagnosis of bladder tumours.