Metachronous upper tract urothelial cancer (UTUC) is encountered in about 5% of patients after radical cystectomy (RC) with a median time to diagnosis of 24-36 months after RC, and most are asymptomatic and detected by surveillance protocols. In this multivariate analysis of retrospective data from 3170 RCs, the authors seek to identify clinicopathological risk factors for the 167 patients who developed UTUC. These risk factors were positive surgical margins, history of prior BCG treatment, carcinoma in situ in the cystectomy specimen, and preoperative hydronephrosis. The authors present a scoring system to aid a risk-adapted approach to planning surveillance. The risk of UTUC was confirmed to be low, at 4%. The five-year UTUC recurrence-free survival of 99%, 96% and 89% in low, intermediate and high-risk patients. A quarter of patients were classified as low risk (no risk factors) who rarely have UTUC more than five years after RC. In these patients there is a case for reducing the intensity of the surveillance protocol, taking into consideration performance status, comorbidities, and patient preference.