Objectives. To review bladder specimens referred to our facility for secondary review to determine the frequency and degree of changes in pathological diagnoses, which could affect patient care. Methods. A retrospective review of 246 bladder specimens sent to our pathology department for second opinion pathological review was performed. All consultation specimens were reviewed by a single genitourinary (GU)-subspecialized surgical pathologist. Any changes in the pathological grade, stage, or histological tumor type were noted as well as patient demographic data. Statistical analysis was performed to determine the frequency and type of discrepancies in diagnoses and determine any associations with patient demographic parameters. Results. Secondary pathology consultation of 246 bladder specimens from 233 patients were reviewed and compared with the primary diagnosis. The diagnosis was altered in 91/246 cases (37.0%). The number of cases reviewed per patient and specimen type was not associated with a change in diagnosis (P = .19; P = .1). Of the cases with a change in diagnosis, 8 (8.8%) changed malignancy status, 46 (50.5%) changed stage, 16 (17.6%) changed tumor type (ie, change from urothelial carcinoma to prostate adenocarcinoma), 16 (17.6%) changed histological variant subtype, and 14 (15.4%) changed grade. There was no association noted between age, gender, or race and changes in diagnosis (P = .53; P = .41; P = .70). Conclusions. Secondary pathology review with a GU-subspecialized surgical pathologist can change the stage, grade, or histological subtype on bladder biopsy and tumor resection specimens in more than one-third of cases. Age and gender were not associated with the frequency of change in diagnosis on consultation review.