The goal of treating ureteral calculi is to achieve complete stone clearance with minimal patient morbidity. Shock wave lithotripsy (SWL) and ureteroscopy have become standards of care for ureteral calculi. However, the optimal choice of treatment depends on various factors, including stone size, composition and location, clinical factors, equipment availability, and surgeon capability Currently, many procedures such as transureteral lithotripsy (TUL), SWL, percutaneous nephrolithotripsy (PCNL), laparoscopic ureterolithotomy (LU), and open ureterolithotomy are used to treat this urological problem. Additionally, TUL with different sources of energy (i.e. laser, pneumatic, ultrasonic, and electrohydrolic) and with different modifications (i.e. urethral occlusion balloon catheter and stone cone) is widely used in the treatment of proximal ureteral stones but its efficacy decreases in large stones. When stone removal is indicated, SWL and ureteroscopy (URS) are the two most commonly offered interventional procedures and they are both acceptable as first-line treatments. However, for stones < 10 mm, SWL at 90%, had a higher stone-free rate than URS .A percutaneous approach may also be indicated for large proximal ureteral stones, especially for large residual stones after PCNL and for impacted stones in hydronephrotic kidneys, as the percutaneous approach provides better results than URS for larger stones . LU has been suggested as a primary modality for large proximal ureteral stones and can be performed safely as a first-line procedure without increasing the complication rate compared with conventional URS. Although LU led to a prolonged operative time, a longer hospital stay, and greater blood loss, it has the advantage of a higher clearance rate in a single procedure . Ureterolithotomy, which has been abandoned in the era of advanced endourology and urolaparoscopy, is generally indicated for failed endourological procedures, particularly in centers that do not have a flexible ureteroscope or a laser lithotriptor, and in patients with larger stones (> 3 cm). Children are also candidates for open surgery, if specifically designed endourological equipment is not available . It is clear that although there are many effective treatment modalities for large proximal ureteral stones, there is no consensus about the modality of choice but the most common procedures are TUL and SWL.