Idiopathic retroperitoneal fibrosis is characterized by excessive fibrotic growth throughout the retroperitoneum. Bilateral obstructive uropathy often suggests possible bladder lesion or external compression of bilateral ureters. A 72-year-old man presented a 15-day history of hematuria and abdominal pain. A CT scan of the abdomen revealed a retroperitoneal mass on the planes of the abdominal aorta, bilateral iliac arteries, and bilateral distal ureters with bilateral hydroureteronephrosis. The patient was successfully treated by implantation of bilateral double-J ureteric stents kept in place for two weeks and use of prednisone and azathioprine. No recurrence of hematuria was observed at one year follow-up. Because standard management of this disease has not been established, further investigation is needed to determine optimal treatment, frequency of imaging to assess disease activity, risk factors of relapse to management, and long-term outcomes.