Urothelial malignancy fascinates the urologist by the range of problems it presents. In superficial bladder cancer, we have reduced the demands of treatment by using fibrescopic technology to make outpatient treatment comfortable and acceptable to our patients. We have adopted a policy of radiotherapy and salvage cystectomy to try to preserve bladder and sexual function in our patients with invasive bladder cancer. The results of recent histological studies may help us to predict which patients will respond to radiotherapy so that we can offer alternative treatment to those who will not. At present, the endoscopic management of tumours of the upper urinary tract poses technical difficulties which will resolved only after further advances in technique and instrumentation.