Objective To explore the risk factors of intravesical recurrence (IVR) of upper-tract urothelial carcinoma (UTUC) after surgery. Methods The medical records of 445 patients with complete follow-up data and undergoing UTUC surgery in our hospital from Jan. 2008 to Dec. 2017 were collected in this study. The baseline demographics, surgical methods, postoperative pathology, follow-up data and other related information were analyzed. Risk factors of the IVR were analyzed by univariate and multivariate Cox regression models. Results The median follow-up time was 33.5 months, and the IVR rate was 18.0% (80/445), of which 66.2% (53/80) occurred within one year after surgery. Univariate Cox analysis revealed that aged ≥ 65 years old (odds ratio[OR]=1.99, 95% confidence interval[CI] 1.22-3.22, P<0.01), with history of bladder cancer (OR=2.69, 95% CI 1.71-4.24, P<0.01), receiving nephron-sparing surgery (OR=2.15, 95% CI 1.30-3.57, P<0.01), and cancer occurring in the lower segment of ureter (OR=1.40, 95% CI 1.11-1.78, P<0.01) were significantly related to IVR of UTUC after surgery. These risk factors were also independent risk factors of IVR of UTUC after surgery in the multivariate Cox regression model. Conclusion Aged ≥ 65 years old, bladder cancer history, receiving nephron-sparing surgery and cancer occuring in lower segment of ureter are the independent risk factors of IVR of UTUC after surgery. The UTUC patients with these risk factors should be suggested to receive careful surveillance and regular cystoscopy examination.