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Pancreas carcinoma is sometimes notoriously difficult to diagnose. Although it is well known that pancreas carcinoma can invade contiguous organs, no attention to urinary tract involvement is paid. Although urinary tract is involved at a late stage, it may represent the first symptomatic evidence of the disease. In such cases, pancreas carcinoma can be presented initially as a urologic disease and patients' symptom may not be differentiated from urinary tract diseases. Computed tomographic (CT) images and medical records of 50 patients with histologically proved pancreas carcinoma were reviewed. There were 10 cases with urinary tract involvement. IVP study was performed in 8 of these cases. Of the 10 cases 8 were male and 2 were female. There was a high incidence of left urinary tract involvement (left:right:bilateral = 7:2:1). Nine cases were pancreas body and tail carcinoma and 1 case was pancreas head carcinoma. The stages were all in IV. All cases were with confirmed evidence of urinary tract involvement at autopsy within 4 months following CT studies. We compared those IVP, CT images and findings of autopsy. In these patients, 4 cases showed direct invasion of the kidney, 5 cases ureteral involvement and 1 case metastasis to the urinary bladder and ureters. IVP showed inferior displacement of the kidney and/or ureteral displacement on the affected side, as well as collecting system distortion, including hydronephrosis secondary to ureteral compression. CT scan showed an abnormal mass which is contiguous to the pancreas, showing compression of the kidney and/or retroperitoneal extension with ureteral involvement. Metastasis to the urinary bladder is also identified.(ABSTRACT TRUNCATED AT 250 WORDS)