Mutations in the promoter of the TERT gene were present in 74% of 76 noninvasive urothelial neoplasms in a recent study. Analysis of 14 patients treated for early bladder neoplasms with TERT mutations detected these mutations in follow-up urine analysis for seven of the eight patients with disease recurrence, but none of the six patients without recurrence, suggesting a potential role in the early detection and monitoring of neoplastic bladder disease.