Disagreement exists about the accuracy of excretory urography in the staging of bladder cancer. During a 10-year period 38 of 524 patients with carcinoma of the bladder had ureteral obstruction on excretory urography at the time of the initial diagnosis. All 38 patients had lamina propria invasion and 35 had muscle invasion at staging transurethral resection. Of those patients 22 had exploratory laparotomies, 11 after 4,000 to 5,000 rad. Of the patients undergoing laparotomy 55 per cent had metastases. Ureteral obstruction at the time of initial diagnosis of bladder cancer usually indicates muscle invasion and/or metastases.