A 71-year-old male presented with flank pain, irritative lower urinary tract symptoms (LUTS), recurrent UTI and a history of two unsuccessful transurethral lithotripsy (TUL) procedures performed at another urology center. Imaging and endoscopic evaluation revealed a duplex system of the left kidney with an associated ureterocele containing a calculus. The roof of the ureterocele was incised (unroofed), allowing direct access to the stone, which was subsequently fragmented and removed via litholapaxy. At the conclusion of the procedure, two double-J stents were placed to ensure adequate drainage and facilitate healing. The stents were removed six weeks later, after which the patient remained asymptomatic, and all presenting complaints had resolved.