A high standardized incidence rate of urothelial cancer (UC) has been reported amongst patients with end-stage renal disease (ESRD) and on patients who have undergone kidney transplant in Taiwan. We calculated both the standardized incidence ratios (SIRs) and cumulative incidence rate (CIR40-84) for UC within the ESRD population in Taiwan using the reimbursement data obtained from the National Health Insurance (NHI) during the period 1997 to 2008. We found that the CIR40-84 of upper tract UC appears to drop after ban of AA (aristolichic acid)-associated herbal products in 2003 for both genders. The CIR40-84 of lower tract UC in males also drops after the year of 2000, which seems to be compatible with the decreased smoking rate beginning in 1990. Female patients diagnosed of ESRD were found to have 9-16 and 11-18 times of elevated risks of LTUC and UTUC, while those of males were increased up to 4-8 and 7-14 times. After consideration of possible etiological agents, we suspect that the epidemic of UC might be associated with the consumption of Chinese herbal products containing AA.