Objective To investigate the feasibility and safety of retroperitoneal laparoscopic nephrectomy in the treatment of nonfunctioning kidney with severe hydronephrosis.Methods 46 cases of nonfunctioning kidney with severe hydronephrosis in our hospital from January 2007 to December 2013 were selected,22 cases in whom received retroperitoneal laparoscopic nephrectomy (RN group),24 cases received open nephrectomy (ON group).Perioperative indexes of two groups were observed and analyzed.Results There was no statistically significant difference in average operation time between RN group and ON group [(129.3 ± 20.5)min vs.(118.2 ± 19.3)min,P > 0.05].The intraoperative blood loss of RN group was less than that of ON group [(162.0 ± 22.1)ml vs.(259.2 ± 18.5)ml],with statistically significant difference (P < 0.01).The incision length of RN group was less than that of ON group [(47.3 ± 19.4)mm vs.(151.2 ± 25.2)mm],with statistically significant difference (P < 0.01).The intestinal function recovery time [(25.6 ± 4.9)h] and hospital stay [(8.1 ± 1.8)d] of RN group were less than those of ON group (P < 0.01).The postoperative complication rate of RN group was lower than that of ON group (9.1% vs.33.3%; P < 0.05).Conclusion Retroperitoneal laparoscopic nephrectomy in the treatment of nonfunctioning kidney with severe hydronephrosis is feasible and safe. Key words: Retroperitoneal laparoscopic; Nephrectomy; Nonfunctioning kidney with severe hydronephrosis