Editor,—Large numbers of patients are seen in departments of genitourinary medicine with symptoms suggesting infection or inflammation of the genitourinary tract. Although bladder neoplasms typically cause painless haematuria, in a subgroup of patients they cause other urinary symptoms that may produce diagnostic confusion. We identified five patients who were referred to the genitourinary medicine service, and who were found to have bladder carcinoma (see table 1). Four of the patients presented to the genitourinary medicine department at High Wycombe (5500 new attendances per annum) between 1991 and 1998; the fifth patient presented to the Oxford genitourinary medicine department (9000 new attendances per annum) …