Objective: To explore the clinical outcomes and postoperative recurrence of laparoscopic radical nephroureterectomy (RNU) combined with bladder sleeve resection for the treatment of upper urinary tract urothelial carcinoma (UTUC). Methods: Clinical data of 98 patients with UTUC were retrospectively analyzed. Intravesical recurrence-free survival (IVRFS) was the primary endpoint, and extra-vesical progression-free survival (EV-PFS) was the exploratory endpoint. Survival outcomes and associated factors were analyzed using Kaplan-Meier and Cox models. Results: The median age was 67.0 (61.2, 73.0) years, and grade ≥ III complications occurred in 6.1%. During a median follow-up of 34.0 (22.5, 44.5) months, intravesical recurrence, local recurrence, distant metastasis and cancer-specific death occurred in 42 (42.9%), 25 (25.5%), 22 (22.4%) and 18 (18.4%) patients, respectively. The IVRFS rates for 1, 2, and 3 years were 69.4%, 60.3%, and 52.9%, respectively, while the EV-PFS rates were 78.1%, 62.9%, and 50.3%, respectively. Non-pelvic tumors were associated with worse IVRFS, while stage ≥ pT3 and lymphovascular invasion were associated with worse EV-PFS. Conclusion: Laparoscopic RNU combined with bladder sleeve resection for the treatment of UTUC has reliable perioperative safety. Given the prevalence of postoperative bladder recurrence, it is recommended to conduct a stratified evaluation of bladder recurrence and extra-bladder progression during clinical follow-up.