Introduction High demand for cystoscopies performed for bladder cancer diagnosis or surveillance imposes significant burden or regional centers with limited capacity. CXBladder is a urinary biomarker test that estimates the likelihood of bladder cancer. International and Australian studies suggested its utility in excluding patients for bladder cancer, reducing unnecessary cystoscopies(1,2). We conducted a prospective observational study to validate its performance in our centre. Methods Included patients presented for flexible cystoscopy for either workup of haematuria, or bladder cancer surveillance. Exclusion criteria included active urinary tract infection, or recent urethral instrumentation. Patient characteristics from electronic records and a single urine sample were collected and analysed. Results 73 patients were eligible for analysis. 41 patients tested positive, 6 of whom proceeded to surgery for tumour removal. Among the 32 patients testing negative, two proceeded to surgery (NPV=0.94, PPV= 0.16). In this cohort, only two patients (2.7%) had confirmed bladder cancer. One patient was newly diagnosed with low grade Ta tumour; the other had a high-grade Ta recurrence. Both tested CXBladder positive (NPV =1). Conclusion CXBladder is useful to exclude bladder cancer, reducing the need for cystoscopies. Reference: 1.Li K et al. Cxbladder Monitor testing to reduce cystoscopy frequency in patients with bladder cancer. Urol Oncol. 2023;S1078-1439(23)00009-1. 2.Koschel S & Zargar H A prospective observational study assessing CxBladder compared to conventional haematuria workup for detection of urothelial carcinoma [Conference presentation]. USANZ Victorian Section Meeting 2023, Melbourne, Australia