Objective To determine the efficacy and incidence of complications of extracorporeal shock wave lithotripsy (ESWL) compared with pneumatic ureteroscopic lithotripsy (URSL) in the treatment of lower uretheral calculi Methods From August 1997 to June 1999, 210 patients with lower ureteric calculi were treated with ESWL and the other 180 with URSL The stones were fragmented with pneumatic lithotripter The outcome was assessed by evacuation, retreatment and complication rates Results ESWL for lower ureteric calculi resulted in a stone evacuation rate of 78 1%, compared with 93 3% for URSL ( P <0 05) ESWL had a retreatment rate of 11 9% and a perforation rate of 0, while URSL caused perforation of ureters in 3 3% of patients and a refreatment of 2.2% Conclusion For the management of lower ureteric calculi, ESWL provides a non invasive, simple and safe option, and URSL has a higher stone evacuation rate but causes ureter perforation more frequently than ESWL does Both ESWL and URSL have their respective advantages It is recommended, however, that URSL be extensively developed for better treatment efficacy, given that the operator has an adequate technical background Objective To determine the efficacy and incidence of complications of extracorporeal shock wave lithotripsy (ESWL) compared with pneumatic ureteroscopic lithotripsy (URSL) in the treatment of lower uretheral calculi Methods From August 1997 to June 1999, 210 patients with lower ureteric calculi were treated with ESWL and the other 180 with URSL The stones were fragmented with pneumatic lithotripter The outcome was assessed by evacuation, retreatment and complication rates Results ESWL for lower ureteric calculi resulted in a stone evacuation rate of 78 1%, compared with 93 3% for URSL (P <0 05) ESWL had a retreatment rate of 11 9% and a perforation rate of 0, while URSL caused perforation of ureters in 3 3% of patients and a refreatment of 2.2% Conclusion For the management of lower ureteric calculi, ESWL provides a non invasive, simple and safe option, and URSL has a higher stone evacuation rate but causes ureter perforation more frequently than ESWL does Bo th ESWL and URSL have their appropriate advantages It is recommended, however, that URSL was extensively developed for better treatment efficacy, given that the operator has an adequate technical background