Because of few associated complications and rapid recovery, dorsal incision into lumbar region has experienced a resurgence in popularity for the treatment of a variety of renal and upper ureteral disorders. We report a case of pyelolithotomy via the dorsal approach in which a symptomatic lumbar incisional hernia subsequently developed, which to our knowledge is a previously unreported complication of this approach. Reconstruction of this lumbar hernia defect necessitated the application of synthetic mesh graft sandwiched by mobilized muscle flaps. The entire repair was then sutured inferiorly to the iliac crest using drill holes. Outcome was durable and successful. The pathogenesis and treatment of this complication are discussed.