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Urological malignancies during pregnancy are extremely rare, affecting about 13 in 1,000,000 pregnancies. Common signs of urological malignancies especially bladder tumors such as hematuria, urgency, lower abdominal pain, may be attributed to the pregnancy. Combined with the hesitancy to undergo imaging, these overlapping symptoms may result in delayed diagnosis. We report the case of a young female who was incidentally detected to have a large bladder tumor during the second trimester of her pregnancy. She underwent a transurethral resection of the bladder tumour during 26th week of pregnancy and histopathology was suggestive of a high-grade lamina invasive urothelial carcinoma. Her pregnancy continued till 34 weeks, when she delivered a 2.14 kg healthy female child. Restaging transurethral resection of the bladder tumour done four days after delivery was negative for malignancy. She is presently on intravesical Bacillus Calmette-Guérin therapy. Although a rare occurrence, treatment of bladder malignancies during pregnancy requires a multidisciplinary approach while taking into consideration the mother’s health, neonatal outcome and the perspective of both parents.