We retrospectively analyzed the clinical courses of 7 patients with clinically unconfirmed positive urine cytology characterized by persistent positive urine cytology but without any evidence of tumor by endoscopy or image diagnosis during the time from January 1999 to June 2004. A past history of urothelial cancer was found in 5 patients. In 2 of these 5 patients, transurethral resection of the bladder mucosa and ureteroscopy done as the initial examination identified bladder cancer and ureteral cancer, respectively. Urothelial cancer was found in the remaining 3 patients by subsequent endoscopy, image diagnosis and surgical resection that were done in the follow-up period of 8 months. Two patients who did not have a history of urothelial cancer were diagnosed as having bladder cancer and ureteral cancer in the initial or subsequent examination. Patients with clinically unconfirmed positive urine cytology should be carefully followed up with endoscopy and image diagnosis since the subsequent examinations tend to identify urothelial cancer in the upper urinary tract or bladder.