Preoperative hydronephrosis may be associated with aworse outcome in patients who undergo radical cystectomy forinvasive bladder cancer. We analyze the prognostic significanceof hydronephrosis, and its relationship to cancer stage andoutcome.We also evaluate concordance between the side ofidentifiable hydronephrosis and concomitant pelvic lymph nodemetastasis. We analyze information from our prospectively collecteddatabase of patients who underwent radical cystectomy forinvasive bladder cancer, at the urology department, Kasr El Ainihospital, Faculty of medicine, Cairo University.A total of fifty patients with bladder cancer clinical stage2, 3, 4 with or without hydronephrosis. Of the studied cases, 19 (38)% had no hydronephrosis,while 31 (62)% had hydronephrosis. Unilateral hydronephrosiswas found in 18\31 (58)% and bilateral hydronephrosis in 13/31(42)%.Of the eleven cases with node positive disease, 6/11(54.5)% had bilateral pelvic node disease, right in 3/11(2703)%of cases, left in 2/11(18.2)%. Nine cases with hydronephrosishad concomitant node positive disease. Preoperative hydronephrosis is an independent predictor ofextravesical disease, but not an independent indicator of nodepositive disease. This suggest that, preoperative hydronephrosis,is an indicator of advanced disease in form of extravesicalextension, but not a nodal metastasis