Although a filling defect within the ureter is the most common finding with ureteral transitional cell carcinomas (TCCs), little is known about the correlation between filling defect patterns and pathologic findings. This study was conducted to address this. Between January 1995 and January 2003, 126 pathologically confirmed TCCs of the ureter were included in our study. We classified urographic filling defects into four patterns: ovoid, polypoid, infiltrating, and plaque-like. The correlation between different filling defect patterns and pathologic findings was assessed using Pearson's Chi-squared and logistic regression methods. There were 28 (22%) ovoid filling defects, 42 (33%) polypoid filling defects, 37 (29%) infiltrating filling defects, and 19 (15%) plaque-like filling defects. Infiltrating and plaque-like filling defects were significantly associated with more advanced disease compared to ovoid and polypoid filling defects (odds ratio, 6.75; 95% confidence interval, 3.04-14.98; p < 0.0001). Our results suggest that filling defect presentations may signify different invasive behavior among TCCs. The distribution of ovoid, polypoid, infiltrating, and plaque-like filling defect patterns is significantly different between superficial and advanced ureteral TCCs. We suggest that classifying the filling defect patterns of ureteral TCCs may provide important preoperative information for planning treatment and predicting outcome.