Carcinoma bladder is among the top ten most common cancer types in the world,with approximately 550,000 new cases annually.¹ In about 75%, the disease isconfined to the mucosa and lamina propria and denoted as non-muscle invasive bladder cancer (NMIBC). Management of bladder cancer is dependent on exact staging using and involves differentiation of Ta,T1 and T2 disease.

Restage TURBT is an important aspect and standard of care in selected patients for any high grade Carcinoma Urinary Bladder and both the European Association of Urology (EAU) and American Urological Association guidelines recommend restage TURBT in all T1 as well as all high-grade tumors.^2,9

Standard method of restaging is by TURBT using cautery loop. There are a number of disadvantages that it has to be done under Spinal/General Anaesthesia and additionally cautery artifacts may interfere with the accurate diagnosis of stage of disease..

                     In Indian setup, the problem of restage TURBT are logistics, cost of repeat surgery,long waiting list and the complications associated with TURBT, such as bladder perforation and stricture⁴. Moreover, restage may not be performed in the stipulated time because of lack of Operataing Theatre slot availability in public hospitals or poor compliance of patients.

                     So an alternate technique of taking biopsy is available in form of Cold Cup biopsy which could be performed as Office biopsy but adequacy of biopsy using Cold Cup has not yet been established.In our study,we would perform Cold cup biopsy under General /Spinal anaesthesiaand if results are similar then it could be performed as an office procedure under local anaesthesia.

                     In this study our aim is to perform a non inferiority trial of obtaining the bladder biopsy by cold cup and comparing it with the standard method of cautery loop biopsy during a restage TURBT.