To investigate the clinical relevance of p27 and mdm2 gene expression in transitional cell carcinoma (TCC), urine samples were collected from 30 TCC patients (preoperatively), 10 patients with nonmalignant urological diseases and 10 controls. Total RNA was extracted from urine sediments and RT-PCR was performed. Absence of p27 mRNA and mdm2 acquisition was specific for grade III TCC. Recurrences significantly increased with schistosomal infection and larger tumor size. Overall survival significantly shortened with larger tumor size, tumor multiplicity, and solid tumor growth pattern. In multivariate analysis, the tumor growth pattern was significant prognostic factor (p=0.036) for disease-free and overall survival while, high grade (exactly significant) and solid tumor growth pattern (p=0.023) were significant prognostic factors for the p27-/mdm2+ genetic pattern in TCC. We conclude that efficient management of TCC would be enhanced using p27 or mdm2 mRNAs as molecular grading markers. [Turk J Cancer 2008;38(2):68-77]