We followed 657 primary bladder carcinoma patients for at least 10 years or until death. Subsequent carcinomas of the renal pelvis or ureter were found in 11 patients (1.7 per cent) 10 months to 13 years after the primary bladder tumor. In 3 patients the tumors were diagnosed or suspected by excretory urography, while in 5 the tumors were not found until autopsy. Four patients had undergone cystectomy and 9 had multiple bladder tumors at the initial assessment or during followup. The initial or recurrent bladder tumor involved the ipsilateral ureteral orifice in 6 patients. We conclude that in bladder cancer patients routine excretory urography is not indicated in the absence of upper urinary tract symptoms but it should be performed in selected patients, that is those with multiple and recurrent bladder tumors or tumors involving the ureteral orifices, or those with a previous cystectomy.

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Two hundred and fourteen bladder carcinomas were evaluated retrospectively after reclassification of histological specimens according to UICC. Follow-up time was 7 years or longer. Large size but not multiplicity of the primary tumour indicated a poor prognosis. Local infiltration, even if superficial and restricted to the lamina propria, worsened prognosis as well as high grade of the tumour. Late deaths in the present series were generally explained by a progression in stage in patients with high grade tumours at initial assessment. Therefore a close longterm follow-up should be performed in these patients.

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Carcinoma in situ of the renal pelvis in a patient with an ileal conduit is reported. By fiberendoscopy, using gastrointestinal instruments, both ureters were catheterized. Cytological investigation of urine from each kidney revealed that malignant cells were exfoliated from the left side exclusively. The correct diagnosis of a carcinoma in situ of the left renal pelvis was confirmed by a histological examination of the operative specimen.