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Painless hematuria is the presenting symptom in 85–90% of patients with bladder cancer.Objectives: To evaluate the efficacy of voided urinary cytology and ultrasonography in the diagnosis and follow up of bladder cancer compared to cystoscopy as a gold standard with reference to its grade. To recommend a protocol that improves the overall sensitivity and specificity of detection of new cases and recurrence in the follow up of patients with bladder cancer.Subjects and methods: A prospective analysis of patients with painless hematuria and follow up patients of bladder cancer was done. They were subjected to voided urinary cytology and ultrasonography. The results were compared with the inferences drawn from cystoscopy and histopathological examination of the resected tumor, wherever applicable.Results: The sensitivity of urinary cytology and ultrasonography was 13.33% and 66.67%, respectively, compared to cystoscopy as a gold standard, whereas the specificity of urinary cytology and ultrasonography was 100% and 93.33%, respectively. Cytology was positive only in high grade cases.Conclusions: Voided urinary cytology can be omitted as a screening test. Ultrasonography can be recommended as the initial imaging investigation for detection of bladder carcinoma in patients presenting with hematuria and for follow up of bladder carcinoma patients

Efficacy of voided urinary cytology and ultrasonography compared to cystoscopy in the detection of urinary bladder cancer