Laparoscopic pyeloplasty is rapidly becoming the gold standard in the repair of adults with uretero-pelvic junction obstruction. Renal calculi are a recognized complication of uretero-pelvic junction obstruction and their presence has often been used to justify percutaneous nephrolithotomy and endopyelotomy as primary treatment. Stones developing secondary to uretero-pelvic junction obstruction have been removed through simultaneous laparoscopic pyeloplasty and pyelolithotomy, but with rigid laparoscopic instruments access is limited to the renal pelvis. As exemplified within this report, endourologic techniques such as flexible ureteroscopy can be combined with laparoscopic pyeloplasty to deal with complex stone disease and to provide optimal treatment of the patient with a uretero-pelvic junction obstruction.