Extracorporeal shock wave lithotripsy (ESWL). The treatment of middle ureteral stones is not effective because the pelvis affects the positioning, and in female patients with lower ureteral stones, there is a risk of damage to the uterus, adnexa and fallopian tubes. The upper ureteral stones are relatively easy and accurate to locate, and ESWL treatment is more effective than the middle and lower ureteral stones. For stones in the upper ureter that cannot be removed by conservative treatment, ESWL is still the first choice. However, the efficacy of ESWL is not satisfactory for embedded stones, narrowing or distortion of the urinary tract below the stone, concurrent ipsilateral renal stones and severe renal insufficiency. Obviously, the efficacy of ESWL in treating upper ureteral stones is affected by many factors, including stone size, stone residence time, whether the stone is embedded, whether the distal ureter is obstructed, ipsilateral renal function, intestinal cleanliness, and patient’s fatness, which leads to limitations of ESWL in treating ureteral stones. Ureteroscopic lithotripsy (URL). However, due to the obstruction of the upper ureteral stones, the proximal ureter is often dilated, and the stones can easily flow back into the kidneys when the stones are struck or the water flows, which is the main reason why URL is relatively ineffective in treating upper ureteral stones. Retrograde endoluminal treatment of ureteral stones has the lowest stone removal rate in the upper part of the ureter compared with the middle and lower parts. Combining ESWL treatment can significantly improve the efficacy. Percutaneous nephrolithotomy for stone extraction (PCN, MPCNL). In the treatment of upper ureteral stones, a Peel-away plastic sheath is pushed into the upper ureter to fix the stones, and then lithotripsy and stone retrieval are performed to avoid stones flowing into the kidney, which greatly improves the stone removal rate, and most of the stones are removed in phase I. The stone removal rate of upper ureteral stones treated with MPCNL was 100%, which was significantly better than that of URL group. The treatment of upper ureteral stones with ESWL, URL and MPCNL has its own advantages and disadvantages. The author’s experience: ESWL is less invasive, less expensive, and can be performed in an outpatient setting, but it has certain limitations, and the complexity of stones should be fully understood and cases should be selected reasonably. Theoretically, URL treatment is feasible for all upper ureteral stones, but in practice, we found that: the angle between ureteroscope and upper ureteral stones is large, which is inconvenient to operate, and it is difficult to remove stones at once, and it takes longer time to remove stones after operation; the operation time is longer when the stones are large, and repeated stone clamping may cause damage to the ureteral opening and lumen. Mucosal damage; stones can easily reflux to the kidney and the treatment effect is poor. Compared with ESWL, URL has significant advantages in relieving acute ureteral obstruction, upper ureteral negative stones and stones that cannot be localized by ESWL in obese patients, and it can deal with ureteral polyps and strictures at the same time. According to the author’s experience, stones in the upper ureter that are relatively low and small can be easily removed by direct clamping or by clamping after fragmentation, while larger stones should be fragmented to avoid mucosal damage caused by repeated clamping in and out of the ureter. MPCNL is effective, but it requires a skin nephrostomy, which is still invasive, and the cost of hospitalization is higher, and it is more risky for upper ureteral stones without hydronephrosis. Therefore, the three methods cannot replace each other in the treatment of upper ureteral stones, and should be chosen according to the specific situation of the stone. Two or more methods can be combined for treatment.