Background: Wide spectrums of nonneoplastic and neoplastic lesions are observed in urinary bladder. Correlation between clinical findings and histopathological features is essential in arriving at a correct diagnosis. This study is undertaken to analyse the pattern of lesions in cystoscopic bladder biopsies. Methods: This retrospective study consists of 70 cases of cystoscopic bladder biopsies carried out in the department of pathology. Clinical details of the patients were retrieved from the file. Specimens were processed routinely and stained with hematoxylin and eosin. Results: Three specimens out of 70 biopsies were inadequate for reporting. Of the remaining 67 cases, 38 were (56.7%) neoplastic and 29 (43.3%) were nonneoplastic lesions. The majority of the cases were seen in the age group of 41-50 yrs (29.9%) with a male predominance (73.1%). Urothelial tumours (94.7%) were the predominant lesions observed under neoplastic category, of which invasive papillary urothelial carcinoma (80.6%) was the most common subtype. Among nonneoplastic lesions, chronic nonspecific cystitis (51.7%) was the commonest lesion noted Conclusion: There are wide ranges of lesions exist in the bladder. Urothelial tumours were the predominant lesions seen in cystoscopic biopsies followed by cystitis. Accurate diagnosis and early intervention is the key for better treatment outcome.