Inclusion Criteria:  Biopsy proven UTUC with plan for excisional surgery (distal ureterectomy or nephroureterectomy) with curative intent Age 18 - 90 years Life expectancy > 1 year Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Female participants who become pregnant or who suspect that they are pregnant should notify the treating investigator immediately. Ability to understand and the willingness to sign a written informed consent.  Exclusion Criteria:  Concurrent or prior diagnosis of bladder cancer with a disease-free interval of less than three years. Synchronous bilateral upper tract urothelial carcinoma (prior history of contralateral UTUC is permissible with a disease-free interval of more than three years). Plan for radical cystectomy. 3.2.4 Suspicion for small bladder capacity (< 100 mL) based on treating urologist's clinical judgment. History of allergic reactions attributed to compounds of similar chemical or biologic composition to gemcitabine or other agents used in study.