Macroscopic haematuria is the most common first symptom of bladder cancer. Macroscopic haematuria is an indication for urgent evaluation in a urological unit. The investigations to be carried out are cystoscopy, urinary cytology and upper urinary tract imaging either with ultrasonography or computed tomography (CT) scanning. Although asymptomatic microscopic haematuria does not often need further evaluation, the decision must be taken with individual risk factors in mind. Bladder cancer is associated with a very high risk of recurrence which warrants regular follow-up. Despite the recurrence the prognosis of superficial disease is good.