Verrucous carcinoma is a well differentiated squamous cell carcinoma with a well known histological appearance and clinical behaviour. We present a case of verrucous carcinoma extensively affecting the urothelium of the right renal pelvis, right ureter and urinary bladder over a 3-year period. This pan-urothelial involvement of a verrucous carcinoma has not been previously reported. The potential for regional spread with subsequent urinary tract obstruction by this tumour calls for aggressive local surgical treatment as the main modality of therapy.