<prompt> A 55 year old smoker presents with history of five episodes of macroscopic hematuria each lasting for about 4-5 days in the past five years. Which of the following inverstigations should be performed to evaluate the suspcted diagnosisUrine microscopy and cytologyX-ray KUBUltrasound KUBDTPA scan  <response>: REPEAT QUESTION. In this case, we should suspect bladder carcinoma transitional cell carcinoma . Smokers are at a higher risk of developing TCC.Other risk factors being chemical .industry workers in western countries and schistosomiasis in endemic regions . It is more common in males -3:1. They usually presents with painless gross hematuria. Thus the best option here is urine microsopy for RBCs and malignant cells.urine cytology even though not a good screening test because of lack of sensitivity is highly specific . Mainstay of diagnosis is cystourethroscopy. investigations include imaging CT , MRI ,USG ,IVU and blood investigations for HB , electrolytes and urea . Bailey and Love 27th edition.chapter 77.pg no 1449. 