OBJECTIVE: To investigate the clinical application value of performing cystoscopy and retrograde ureteral intubation in difficult gynecological laparoscopic surgery. METHODS: Among the patients who underwent gynecologic laparoscopic surgery in our hospital from July 2004 to September 2007, 19 patients with preoperative estimated surgical difficulties were retrograde ureteral intubation using a hysteroscope instead of a cystoscope before laparoscopic surgery operation. In the 9 patients who had difficulty with the laparoscopic procedure, cystoscopy was performed postoperatively using a hysteroscope instead of a cystoscope, while indocyanine was injected intravenously to observe urine spraying at the bilateral ureteral openings. RESULTS: All procedures were successfully completed laparoscopically, and the ureteral catheter was removed at the end of surgery in 19 patients who had retrograde ureteral intubation preoperatively without intraoperative ureteral injury or other complications. In 9 patients with intraoperative difficulties, cystoscopic examination was performed after surgery, and it was found that in one patient, the left ureteral opening had disappeared, and laparoscopic exploration revealed that the ureter was ligated with sutures. All 28 patients had no intraoperative or postoperative complications. Conclusion: Cystoscopy and retrograde ureteral intubation during difficult laparoscopic surgery in gynecology can avoid or reduce the occurrence of ureteral injury, which is feasible and necessary, and is worth promoting in the units where it is available.