Ureteral obstruction secondary to extrinsic compression is uncommon. Extrinsic compression results from both benign and malignant conditions of the retroperitoneum. In certain patients, laparoscopic ureterolysis is a minimally invasive alternative to the open approach. To date, the largest numbers of patients have undergone this procedure for idiopathic retroperitoneal fibrosis. Select patients with ureteral obstruction following cancer chemotherapy or radiotherapy may also be candidates for laparoscopic ureterolysis, although experience is limited. This article reviews the current indications, technique, and results of laparoscopic ureterolysis for both benign and malignant conditions. Further long-term studies are required to define its role.