A series of 52 patients with squamous cell carcinoma of the urinary bladder were studied over a 6-year period. They constituted 27% of all bladder tumours. The male:female ratio was 12:1; 62% of the patients were below the age of 50 years (mean 47) and 31% had a previous history of urinary bilharziasis. Associated stigmata of Schistosoma haematobium, as sandy patches, were detected in 69% of patients. Fourteen had bilharzial ureteric strictures as seen on intravenous urography and most of the tumours occurred in the region of the trigone; 60% had T3 NO MO tumours at presentation. Eighteen patients received radical radiotherapy and 16 patients under the age of 55 years underwent radical cystectomy with diversion of urine to an isolated rectum. The 5-year survival rate in the radical cystectomy group was 75%. Other modalities of treatment and their results are discussed.