A 27-year-old man presented to the urology clinic with painless gross hematuria. He reported several years of heavy daily hookah smoking. He had no history of urinary tract infections, urolithiasis, chronic medical conditions, or previous surgery.

Initial Examinations Unremarkable examination CBC and renal function tests were within normal limits Transabdominal ultrasound: Large, irregular soft-tissue bladder mass Heterogeneous echogenicity Surface irregularity No posterior acoustic shadowing   Figure 1- Transabdominal ultrasound of the urinary bladder. Cystoscopy Large, exophytic papillary tumor Occupying a substantial portion of the bladder Friable and vascular No apparent bladder neck or ureteric orifice involvement Resection and histopathology The patient underwent transurethral resection of the bladder tumor (TURBT) with maximal safe resection. Deep resection was performed to…