The commonest presentation is with macroscopic haematuria, though some patients also have frequency of micturition, dysuria, or symptoms of metastases.

Haematuria should be confirmed by urine analysis and investigated by analysis of the cytology of voided urine and by cystoscopy. An IVU can demonstrate the possibility of disease involving the ureter and the diagnosis is established by resection of the primary tumour at cysto-scopy. During the same procedure, bimanual examination is performed and this, together with the biopsy findings with associated evidence of depth of tumour invasion, enable the T stage of the tumour to be established. Nodal and metastatic staging is achieved with a CT scan of the thorax and abdomen. MRI is an excellent alternative for investigating the local extension of disease and the possibility of pelvic lymphadenopathy.

The staging demonstrated following radical cystectomy may in many cases be different from that established from pure clinical investigation; this is important for comparison ofdifferent treatment series.

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