Upper urinary tract urothelial carcinoma (UTUC) accounts for 5%-10% of urothelial malignancies, with up to 50% of patients developing bladder recurrence post-RNU. High-risk UTUC (≥pT2, high-grade, or N+ disease) necessitates aggressive management. Intravesical chemotherapy mitigates recurrence risk, yet optimal timing-intraoperative vs. postoperative-remains unclear. This study evaluates intraoperative epirubicin instillation during RNU compared to postoperative administration and no instillation.

Inclusion Criteria:

• primary high-risk UTUC.

Exclusion Criteria:

• prior bladder cancer,
• low-risk UTUC (managed conservatively),
• metastatic disease,
• incomplete follow-up

tertiary care clinic