The main objective of the study is to select the best technique for lithotripsy of distal ureteral stones .This study included 082 patients of distal ureteral stone at Al-Assad University Hospital and Tishreen University Hospital in Latakia between 2016 and 2017. 64 patients who underwent ureteroscopic holmium laser lithotripsy and 216 patient who underwent ESWL.The ages ranged from 19-72Years, The median age was approximately 37 year. the success rate of distal ureteral lithotripsy using uretroscope-laser was 97% (100% with stones> 1 cm, and 95% with stones< 1 cm) while it was 72% with the extracorporeal lithotripsy(84% with stones > 1 cm, and 36% with stones < 1 cm). The best results in treating the distal uretral stones were achieved by the use of ureteroscope and laser lithotripsy, regardless of the stone size. While the extracorporeal lithotripsy the best results was only with stones< 1 cm.