Objective To investigate the effectiveness and safety of ureteroscopic dual-frequency double-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (U100 laser) in the treatment of ureteral stones combined with renal failure. Methods The U100 laser was applied to treat 41 cases of ureteral stones combined with renal failure via ureteroscopy, 31 cases of bilateral ureteral stones on 62 sides, and 10 cases of isolated renal ureteral stones, totaling 72 sides. The result of lithotripsy success rate was 95.8% (69/72). Among them, 3 sides had large stones migrated into the renal pelvis, and SWL was performed after the recovery of renal function by indwelling D-J tubes.The postoperative hospitalization was 5-9d, mean 7d; the mean laser working time (8.5±3.5min). There were no serious intraoperative complications such as hemorrhage, ureteral avulsion, and abscess kidney. Renal function returned to normal in 39 cases, and 2 patients with long-term obstruction recovered to the compensatory stage of renal failure. Conclusion Ureteroscopic U100 laser lithotripsy has the advantages of safety, minimally invasive, and fast recovery of patients, and it is an ideal method for the treatment of ureteral stone combined with renal failure.