A 55 years old smoking 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 investigations should be performed to evaluate the suspected diagnosis?

Ans. (a) Urine microscopy and cytologyRef: Smith 17th Edition, Pages 308-315Diagnosis of Urinary bladder carcinoma:* Cystoscopy and transurethral resection is the IOC for obvious lesions.* Urinary cytology is the IOC for carcinoma in situ.* Cytological examination of exfoliated cells from tumor is useful in detecting cancer in symptomatic patients and assessing the response to treatment.* Cytological examination is also most useful to detect early recurrence* CT and MRI are used in stagingExfoliative markers:* NMP22 (Nuclear matrix protein 22)* Hyaluronidase* Lewis X ag* Telomerase activity