If we compare the ureter to the traffic line connecting the kidney and the bladder, the ureteroscope (URS), known as the second sword, is undoubtedly the most active soldier in this traffic line. Did you know? Thanks to it, the unobstructed flow of the ureter is greatly ensured. In the past, the slightest disturbance would have paralyzed this important line of communication. The method and cost of treatment at that time was so frightening, because the only way to restore its smoothness was through open surgery. Now, with this second sword, stones, strictures, and even early tumors can be easily fixed without surgery. The URS can be used to detect stones through the urethra-vesical-ureteral pathway and then use laser and pneumatic ballistic lithotripsy to break them into fragments, and remove them directly from the body with clamps for large ones or leave them to be discharged on their own. We have recently acquired the most advanced holmium laser lithotripsy system and EMS ballistic lithotripter, which have greatly improved the treatment effect of ureteral stones. The indications for ureteroscopic lithotripsy and lithotripsy (URL) are as follows: (i) stones in the middle and lower ureter are preferred for this treatment; (ii) stones in the upper and upper ureter that have failed to be treated with ESWL and drug lithotripsy; and (iii) ureteral stone streets formed after ESWL treatment. With the second sword of URS, we are now able to perform minimally invasive treatment for most of the ureteral stones, but URS is a double-edged sword, if we ignore the patient’s specific situation, we may lose everything! The failure of URL surgery can be summarized as follows: ① about 10% of patients failing ureteroscopy cannot undergo URL; ② URSL is not recommended for large ureteral stones (R1.5 cm in diameter) because of the difficulty of stone fragmentation and the risk of accidents and complications such as ureteral perforation; ③ there is a possibility of stones wandering into the kidney during URL surgery, and the ureteroscope is mostly out of reach after this happens. The stone wandering is especially likely to be seen in the upper ureter, so extracorporeal shock wave lithotripsy (ESWL) is preferred for these stones.