Experience with a urological waiting list initiative is presented, wherein a list of 231 non-urgent cases was cleared over a 5 month period by a single operator. Some patients had waited 10 years for surgery. Following a postal request, the waiting list was validated; 31.2% of patients wished to be removed. The remaining 68.8% desired surgery and consisted of 51 requiring minor surgical procedures and 108 who needed more major surgery mostly for the relief of bladder outflow obstruction. Minor cases received dates for surgery; however, only 68.2% of this group attended despite being given more than one date for admission. Major cases were reviewed in a pre-admission clinic. General and urological condition was assessed, improved where necessary and surgery booked or delayed accordingly. A small number of patients did not attend or only attended to be reassured that surgery was not needed. Following clinical review, 18.5% of this group did not require operation. The long urological waiting list is a unique situation where patients listed may no longer require surgery. Reviewing these patients not only reduces numbers but also markedly increases percentage attendance for surgery.