The principles of urology and all surgical disciplines were, not too long ago, considered to be rigidly and permanently established. In this exciting era of change, the foundations of urology are now set on shifting sands rather than the bedrock of the past. The pertinent issue clinically is making discriminating evaluations of new developments so that, where appropriate, they are able to be incorporated into treatment practices to improve patient care. In this overview, a personal appreciation of the more important practical and conceptual changes relating to prostatic, urothelial and renal carcinoma during the past 5 to 10 years is presented.