Abstract: Objective: To compare the efficacy and safety of Holmium:YAG laser and pneumatic lithotripsy in the treatment of upperureteral calculi. Methods: The clinical data of 317 patients with upper-ureteral calculi who had undergone ureteroscopic lithotripsy with Holmium:YAG laser or pneumatic lithotripter from June 2007 to June 2010 were analyzed retrospectively and the efficacy and safety were compared. Results: The one-time success rate was 96.5% in the holmium laser group and 86.1% in the pneumatic lithotripter group. The difference was significant(P < 0.01). The operation time of the holmium laser group was significantly shorter than that of the pneumatic lithotripter group(P < 0.05),and there was no significant difference in the hospital stay between the two groups(P > 0.05). All the cases were reviewed by kidney ureter bladder plain 3 days after lithotripsy. The stone-free rate was 98.8% in the Holmium laser group and 92.7% in the pneumatic lithotripter group. The difference was significant(P < 0.05). Ureteral perforation occurred in 3 cases in the pneumatic lithotripsy group. Conclusions: Holmium:YAG laser lithotripsy is superior to pneumatic lithotripsy in treatment of upper-ureteral calculi.