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To investigate the prognostic significance of mean vascular density (MVD) in a variety of transitional cell carcinomas (TCC) obtained by biopsy and cystectomy, and thus determine the importance of vascular density as a prognostic indicator for vesical TCC.Tumour vasculature was visualized using factor VIII immunohistochemistry. The MVDs of tumours from 42 cystectomy specimens were correlated with patient survival over a maximum follow-up of 156 months. The results were also compared with those obtained from initial bladder biopsy in a subset of 29 patients.Twenty-five patients had died over a mean follow-up of 32 months. The MVDs from cystectomy specimens ranged from 29 to 229 vessels per medium-power field (0.94 mm2) while that for biopsies before cystectomy ranged from 51 to 155 vessels. The MVD for both cystectomy and biopsy specimens showed a significant association with survival, but this was absent in a multivariate analysis that included tumour stage and grade, and there was a poor correlation between the MVD of cystectomy- and biopsy-derived tumours.The assessment of tumour vascularity appears to be of little clinical importance for vesical TCC.