For patients with localized upper tract urothelial carcinoma (UTUC), radical nephroureterectomy with bladder cuff excision (RNU+BCE) is the standard treatment. About one third of patients have intravesical recurrence (IVR) after surgery and it usually takes place within 2 years. We reported a case of IVR after 14 years follow-up and performed a literature review about IVR.

A 67-year-old man initially presented with right flank pain, and an abdominal CT scan revealed a right ureteral tumor. Ureterorenoscopic biopsy confirmed invasive urothelial carcinoma. He subsequently underwent right hand-assisted laparoscopic radical nephroureterectomy with bladder cuff excision (RNU+BCE) on March 28, 2010. The final pathology showed invasive urothelial carcinoma with carcinoma in situ, staged as pT1N0M0 (Stage I). Postoperatively, he received intravesical chemotherapy with mitomycin, doxorubicin, and cisplatin (MDC). He was followed regularly with cystoscopy, urine cytology, intravenous pyelography, and renal ultrasound. However, after 14 years and 8 months of follow-up, cystoscopy revealed multiple small papillary tumors. Pathology from transurethral resection of the bladder tumor confirmed high-grade noninvasive papillary urothelial carcinoma (pTa).

Risk factors for IVR after RNU+BCE for UTUC include high tumor stage (≥ pT2), multifocality, carcinoma in situ (CIS), lymphovascular invasion, male sex, and a history of bladder cancer. The timing of IVR varies across studies. Most recurrences occur within the first year post-surgery. Some studies report a median recurrence time of 10 months, while others indicate that 31% of patients experience bladder recurrence at a median of 24 months. In these studies, the average follow-up duration was 5 to 7 years, with one study extending up to 200 months. However, no cases of bladder recurrence were observed beyond 150 months. Our case highlights that although the likelihood of bladder recurrence beyond 10 years is extremely low, it is still possible, emphasizing the need for regular follow-up.

IVR after RNU+BCE for UTUC typically occurs within the first two years, with late recurrence beyond 150 months being extremely rare. Our case, with IVR after 14 years, highlights the importance of prolonged monitoring, as delayed recurrence remains possible despite its low incidence. Regular follow-up is essential for early detection and timely management.