Shock wave lithotripsy of upper ureteral stones is significantly more successful than ureteroscopy. Successful stone manipulation before ESWL increases the stone-free rate, yet impacted stones disintegrate and pass in the majority of patients. Earlier ESWL treatment of symptomatic ureteral stones will decrease patient morbidity and subsequent complication of distal stone passage. Lithotripsy of small renal stones prior to migration and proximal ureteral stones early in their symptomatic course may significantly alter the incidence of distal ureteral calculi requiring hospitalization, cystoscopy, or ureteral endoscopy. Ureteroscopy will remain the treatment of choice for symptomatic distal ureteral stones.