FIG. 25:  What are the options in patients with normal cystoscopy and a positive marker?  If there is a high level of concern, then intraoperative biopsies are indicated.  If there is a low level of concern due to low-risk disease, then one could consider repeating cystoscopy within a short time.  If there is no recent upper tract imaging, then this should be done, especially for patients with high-grade disease.  In the future, enhanced cystoscopy with either a blue light or narrow band imaging in office may be an option to identify lesions missed by white light alone.