Concurrent ureteral and kidney stones pose a substantial clinical challenge. The popularity of retrograde intrarenal surgery (RIRS) has been facilitated by advancements in endoscopic technology, which provide high rates of stone clearance. Conversely, retroperitoneoscopic ureterolithotomy (RLU) has demonstrated non-inferiority to retrograde flexible ureteroscopy in terms of stone-free rates and the necessity for auxiliary procedures, as well as a reduced incidence of postoperative sepsis. The patient in this case was treated with RLU and subsequently underwent trans-trocar retrograde intrarenal surgery for a large upper ureteral stone and minor renal stones. These stones frequently necessitate auxiliary procedures.

A 60-year-old male with a history of left flank pain was diagnosed with a left inferior pole stone and a 2.7 cm proximal ureterolithiasis during imaging. The patient underwent RLU followed by trans trocar- RIRS, with both surgeries performed in a single operation

No complications were reported according to the Clavien-Dindo classification. A follow-up kidney, ureter, and bladder (KUB) radiograph postoperative day 1confirmed no residual stones, and renal ultrasound one month after double-J catheter removal showed no obstructive nephropathy.

In summary, the combination of RLU, trans-trocar RIRS, and stone basket extraction for renal stones is a safe and effective method that eliminates the necessity for stepwise operations or auxiliary procedures. RLU with trans-trocar RIRS can be a viable alternative treatment option for patients with significant stone burdens in both the ureter and kidney.