One hundred and eighty-six patients with primary transitional cell carcinoma underwent radical cystectomy between 1965 to December, 1986. Four of them (2.2%) had developed upper urinary tract transitional cell carcinoma. Three of the 4 patients had received various transurethral treatments for the primary bladder lesions before radical cystectomy, but one patient had undergone total cystectomy and ileal conduit as primary treatment. All of the upper urinary tract tumors were invasive. Three patients died and one is alive. We consider the following to be high risk patients for the development of upper tract recurrence. 1) patients with carcinoma-in-situ and multicentric tumors in the bladder, 2) patients with recurrent bladder cancer treated with bladder preserving treatment for a long periods, 3) patients with vesicoureteral reflux, and 4) occupational bladder cancer patients.