The tobacco-specific nitrosamine N'-nitrosonornicotine (NNN) is carcinogenic to humans (IARC Group 1). Assessing the tobacco smoke-related exposure to NNN by suitable biomarkers is of interest for risk evaluation. Recently, NNN and NNN-N-glucuronide have been quantified in urine of smokers. However, it is unknown what percentage of the absorbed dose of NNN is excreted as total NNN (sum of free and conjugated NNN) in urine of smokers. We developed a sensitive method based on liquid chromatography with tandem mass spectrometry with deuterium-labeled internal standard for the determination of total NNN in human urine. The limit of quantitation of the method was 2 pg/mL with a calibration line linear up to 256 pg/mL. In a study with 16 smokers in which the respiratory retention of NNN was measured through controlled smoking, we found that on average about 1% of the pulmonary NNN dose was excreted in 24 h urine as total NNN.