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Chronic lymphocytic leukemia (CLL) is an uncommon hematological disease affecting people with recurring infection and is associated with increased risk of progression to high-risk cancer. Bladder CLL is a rare disease hence prognosis and best treatment option is not clearly understood. CLL commonly affects middle-aged women. It presents as abdominal pain, urinary difficulty, fatigue and general symptoms like fever, weight loss and loss of appetite. Chemotherapy, surgery, and radiation is the mainstay of treatment. Prognosis depends on multiple factors including subtype, stage of lymphoma, the progression of the condition, response to treatment, and overall health of the patient. The risk of recurrence and progression to other cancer is very high in bladder CLL which necessitates a strict follow-up protocol. We present a case of an 87-years-old patient presenting with persistent non-visible hematuria and storage lower urinary tract symptoms. Hematuria workup leads to the diagnosis of CLL. Hematology multi-disciplinary team recommended follow up.
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