Objective: The purpose of the current study is to perform a standardized comparison of original and internal repeat pathology reviews of identical bladder specimens to identify discrepancies and characterize the impact of repeat review on treatment decisions as well as identify patients most likely to benefit from this practice.Materials/Methods: Ninety-one patients with an outside diagnosis of urothelial cancer of the bladder were referred to our institution for repeat review of 91 bladder resection specimens and biopsies.A discrepancy in either the presence or absence of muscularis propria and presence of invasive disease in the muscularis propria was deemed a "treatment-altering" characteristic, while presence of carcinoma in situ, lymphovascular invasion, or micropapillary features was deemed a "clinically-significant" characteristic. Results:After repeat review at our institution, 29.7% (27) specimens had treatment altering discrepancies, and 61.5% (56) specimens had at least one clinically-significant discrepancy. Conclusion:Repeat review of referred bladder specimens frequently impacts treatment decisions in patients with urothelial carcinoma.