We report a case of retroperitoneal fibrosis with dilation of the upper urinary tract on both sides and impaired renal function in a 66-year-old female. The patient was successfully treated by laparoscopic ureterolysis and intraperitonealization of both ureters with subsequent immunosuppressive medication. Due to intraoperative subcutaneous emphysema, surgical therapy had to be performed as a two-step procedure but postoperative morbidity was minimal with quick recovery. Laparoscopic ureterolysis is a reconstructive procedure and the ureters are accessible in full length either transperitoneally or retroperitoneally.