Objective: To summarize the perioperative outcomes, renal function changes, intravesical recurrence (IVR), and extra-vesical progression (EV-PFS) after laparoscopic radical nephroureterectomy (RNU) with bladder cuff excision for upper tract urothelial carcinoma (UTUC). Methods: A retrospective analysis was conducted on 98 patients who underwent laparoscopic RNU with bladder cuff excision between January 2020 and December 2024 at our institution. The primary endpoint was intravesical recurrence-free survival (IVRFS). The exploratory endpoint was extra-vesical progression-free survival (EV-PFS), defined as time to local recurrence, distant metastasis, or cancer-specific death. Survival rates were estimated using the Kaplan-Meier method, and Cox models were used for exploratory association analysis. Results: Among 98 patients (median age 67.0 years), major complications (Clavien-Dindo ≥III) occurred in 6.1%. During a median follow-up of 34.0 months, IVR occurred in 42 patients (42.9%), local recurrence in 25 (25.5%), distant metastasis in 22 (22.4%), and cancer-specific death in 18 (18.4%). The Kaplan-Meier estimated 1-, 2-, and 3-year IVRFS rates were 69.4%, 60.3%, and 52.9%, respectively. The corresponding EV-PFS rates were 78.1%, 62.9%, and 50.3%. Exploratory analysis suggested that non-pelvic tumors were associated with worse IVRFS, while pathological stage ≥pT3 and lymphovascular invasion were significant predictors of worse EV-PFS. Conclusion: Laparoscopic RNU with bladder cuff excision is perioperatively safe for UTUC. Given the high incidence of IVR, intravesical recurrence and extra-vesical progression should be evaluated separately during follow-up.