The risk of intravesical recurrence remains a critical concern in upper tract urothelial carcinoma (UTUC) following radical treatment. Given the hypothesis that cancer cells retained in vesicles or migrating via a retrograde pathway may contribute to recurrence, this study aims to investigate whether benign prostatic hyperplasia (BPH) is an independent risk factor associated with UTUC recurrence.

We performed the retrospective cohort study based on the TriNETX database between January 2019 and December 2024. Male patients with UTUC received radical nephroureterectomy(RNU) was allocated to 2 cohorts, and separated based on the diagnosis of BPH. Propensity score matching was conducted in order to balance baseline characteristics and avoid covariates. Intravesical recurrence time was defined as a patient receiving transurethral resection of bladder tumor after RNU. The primary outcome was recurrence free survival(RFS) which was compared between two groups and was assessed using Kaplan–Meier analysis.

Using the TriNETx database system, we identified male patients diagnosed with UTUC who underwent RNU. Patients with comorbid BPH were analyzed to assess their impact on recurrence risk. Kaplan–Meier analysis demonstrated a significantly lower RFS in the BPH group compared to those without BPH. Additionally, the proportion of patients undergoing transurethral resection of the bladder tumor (TURBT) for subsequent bladder recurrence was significantly higher in the BPH group. Multivariable Cox regression analysis further demonstrated that BPH was an independent risk factor for intravesical recurrence after RNU.

The presence of BPH may contribute to an increased risk of recurrence in UTUC patients following radical treatment. Further studies are warranted to explore potential strategies for recurrence risk reduction in this patient population.