Objective To investigate the risk factors for recurrence of female vesical leukoplakia after transurethral resection (TUR).Methods Clinical data of 257 patients who underwent transurethral resection of vesical leukoplakia from January 2010 to November 2018 were retrospective collected. 223 patients were followed up. Univariate and multivariate Cox analysis were performed on the risk factors for recurrence of female vesical leukoplakia after TUR.Results The median follow-up time is 49 months (Time range: 12 months to 121 months). Five-year recurrence-free rate and 1-year recurrence-free rate were 86.1% and 91.9%, respectively. Univariate Cox analysis revealed urinary tract infection [hazard ratio (HR) = 2.111, 95% confidence interval (CI): 1.043～4.271, P = 0.038] and atypical urothelial hyperplasia of the bladder (HR = 4.191, 95%CI: 2.006～8.756, P = 0.000) were significant risk factor for recurrence. Multivariate Cox analysis suggested atypical urothelial hyperplasia of the bladder (HR = 3.506; 95%CI: 1.663～7.392, P = 0.001) was an independent risk factor for recurrence of female vesical leukoplakia after transurethral resection.Conclusion Atypical urothelial hyperplasia of the bladder is an independent risk factor for postoperative recurrence of female vesical leukoplakia. Enhanced postoperative follow-up for these factors can reduce the risk of postoperative recurrence.