Background
Upper urinary tract (UUT) obstruction following radical cystectomy (RC) is multifactorial. The causes include strictures, upper tract urothelial cancer (UC) recurrence, stones and extrinsic compression.

Objective
To determine the causes of UUT obstruction in patients following RC.

Method
A database of patients who underwent open, laparoscopic or robotic RC was prospectively maintained over a 10 year period. Patients who had minimum 6 months follow up were included. The cause of UUT obstruction was determined. UUT surveillance was done by computed tomography, loopogram and radioisotope renogram.

Results
Of 317 patients, 250 had 6 months or more of follow up (median 23 months). Forty-one (16.4%) patients had post-RC obstructive uropathy. Twenty-one (8.4%) had benign ureteric strictures, at a median time of 16.5 months post-RC. The other causes were UC recurrence in six (2.4%) found at a median time of 14.5 months, pelvic recurrence in six (2.4%), stoma and para-stomal problems in five (2%), and uncertain aetiology in three (1.2%). A higher portion in the benign stricture group had muscle invasive tumour found during RC when compared to the “non-obstructed” group (54% vs. 47%, p = 0.003).

Conclusion
Our study demonstrated that the most common cause of the UUT obstruction post-RC was benign ureteric strictures, followed by upper tract UC and pelvic recurrence. The majority of UUT obstruction develop within the first 18 months following RC but delayed presentation is possible. It is prudent to monitor the upper tract following RC.