29/07/2026
The commonest story I hear in clinic: "Doctor, there was blood once, about four months ago. It stopped, so I left it."
That single painless episode is the classic presentation of a bladder space-occupying lesion. It stops spontaneously, which is exactly why it gets dismissed by patients, and sometimes by the first clinician who sees it.
What I'd want every patient to know: one episode is enough reason to get evaluated. Settling after antibiotics doesn't rule anything out. Ultrasound can miss smaller lesions.
What I'd say to colleagues: in anyone over 40 with visible haematuria, image the upper tract and scope the bladder. Early cystoscopy changes the stage at which we intervene, not merely the timeline.
The pathway is well established cytology, CT urography, cystoscopy, then TURBT for both resection and staging.
From there, treatment splits on invasion depth: intravesical therapy with surveillance for non–muscle-invasive disease, and multimodal management with cystectomy or bladder preservation for muscle-invasive disease.
The window we have is widest at the first episode. It narrows quietly after that.
Dr. Bivek Kumar, MCh Urology, FRSM | drbivekkumar.com | -in
