This study investigated the impact of the initial clinical presentation of bladder cancer on tumor characteristics. A cross-sectional, retrospective study was performed, and it involved 515 patients who underwent transurethral bladder cancer resection at the University Hospital Center Split between April 2019 and April 2023, excluding recurrent cases. The association between symptomatic versus asymptomatic presentation and bladder cancer characteristics was analyzed. A subgroup analysis compared tumor characteristics between patients with gross and microscopic hematuria. Multiple regression analyses revealed a significant association between symptomatic presentation and the detection of high-grade bladder cancer (OR 3.43, 95% CI 2.22–5.29,p< 0.001), concomitant CIS (OR 3.41, 95% CI 1.31–8.88,p= 0.012), T2 stage bladder cancer (OR 5.79, 95% CI 2.45–13.71,p< 0.001), a higher number of tumors (IRR 1.24, 95% CI 1.07–1.45,p= 0.005), and larger tumor size (B 1.68, 95% CI 1.19–2.18,p< 0.001). In the subgroup analysis, gross hematuria was associated with the detection of high-grade bladder cancer (OR 2.07, 95% CI 1.12–3.84,p= 0.020), T2 stage bladder cancer (OR 6.03, 95% CI 1.42–25.49,p= 0.015), and larger tumor size (B 1.8, 95% CI 0.99–2.6,p< 0.001). The identified associations between symptomatic presentation and unfavorable bladder cancer characteristics, likely attributed to early detection in asymptomatic cases, underscore the importance of additional research in the development of bladder cancer screening strategies.