This review examines aspects of handling biopsies and surgical specimens from the urinary bladder with the aim of providing guidance to ensure that the pathologist is fully able to inform clinicians of all relevant factors that might have bearing on management or prognosis. It also offers recommendations on good practice in reporting in the setting of the specialist multidisciplinary meeting and emphasises quality control of the process, referring to recently published guidelines and consensuses while admitting that many of the recommendations may not be supported by a strong evidence base. The role of urine cytology and the value of frozen sections in urological practice are discussed. Participation in regular clinical audit and the national urological pathology External Quality Assurance (EQA) are recommended.