Background <p>Metachronous upper tract urothelial carcinoma (UTUC) is an uncommon but clinically significant event in patients with non–muscle-invasive bladder cancer (NMIBC), particularly in those with high-risk or recurrent disease. Proposed mechanisms include field cancerization and intraluminal tumor seeding, while ureteric instrumentation has been discussed as a potential contributing factor. Emerging evidence suggests that retrograde ureteric stent placement performed concurrently with transurethral resection of bladder tumor (TURBT) may be associated with an increased risk of subsequent upper tract involvement. We report the first case of bilateral distal ureteric urothelial carcinoma developing in close temporal association with first-time ureteric stent placement in a patient with recurrent NMIBC.</p> Case report <p>A 78-year-old man with recurrent high-grade NMIBC underwent bilateral ureteric stent placement during TURBT for obstructive uropathy, with no prior evidence of UTUC. Within months, imaging demonstrated progressive distal ureteric abnormalities. Subsequent cystoscopy and bilateral ureteroscopy revealed extensive papillary tumors involving both distal ureters with proximal extension, in addition to recurrent bladder lesions. Histopathology confirmed high-grade, non–muscle-invasive urothelial carcinoma. At re-intervention, both indwelling stents were encased within tumor tissue.</p> Conclusion <p>This case highlights the multifactorial nature of metachronous UTUC in patients with recurrent bladder cancer and supports the hypothesis that ureteric instrumentation may contribute to upper tract tumor dissemination in selected high-risk settings. Careful consideration of urinary diversion strategies and close upper tract surveillance remain important when managing patients with active bladder urothelial carcinoma.</p>