<prompt> A 60 year old smoker male patient presents with painless gross hematuria for 1 day. IVU shows 1.2 cm filling defect at the lower pole of infundibulum. Which is the next best investigation to be done?CystoscopyUrine cytologyUSG abdomenDMSA scan  <response>: - 60yr old smoker, hx. of PAINLESS gross hematuria - are findings of CA BLADDER - First investigation to be done is Cystoscopy. Once tumor visualized in cystoscopy, Biopsy done to confirm diagnosis. Urine cytology is done usually for UTI not for Bladder Cancer. A DMSA renal scan is a diagnostic imaging that evaluates the function, size, shape and position of the kidneys and detects scarring caused by frequent infections. BLADDER CANCER: Investigations- IOC for Dx- Cystoscopy Biopsy- Urinary cytology To confirm the diagnosis But location of tumor cannot be identified.- IOC for staging- MRI - Urinary tumor markers BTA Bladder tumor antigen NMP -22 Nuclear Matrix Protein Lewis- X- antigen Hyaluronidase Helpful in diagnosis and for follow up to assist the response of therapy and todetect recurrence 