Synchronous bilateral urothelial tumors of the upper urinary tract are extremely rare and their treatment constitutes a real challenge for urologists. Whereas low grade superficial tumors can be treated using endoscopic procedures, in the case of high grade, invasive or large volume tumors bilateral radical nephroureterectomy with cystectomy is considered the standard of care. The authors present the case of large volume high grade tumors of the renal pelvices in a patient with a history of superficial bladder cancer treated by one-stage bilateral laparoscopic nephroureterectomy and open cysto-prostatectomy. The aim of the study is not only to present the operative technique but also to show that the combined procedure is safe, effective and no more invasive than the operation exclusively performed laparoscopically.