Objective To summarize the clinical experience in rigid ureteroscopy for the treatment of acute obstructive renal failure. Methods From June 2005 to April 2008,totally 127 patients with acute obstructive renal failure were treated by rigid ureteroscopy in the emergency of our hospital. Using EWSL or Holmium laser,the calculi were broken into pieces smaller than 2 mm in diameter. Larger pieces were removed with clamps. Double-J stent was indwelled after the operation. Results In this series,2 patients were converted to open surgery because of failure to insert the ureteroscope owning to ureteral stenosis. In the rest of the cases,the ureteroscopy was succeeded in 151 of the 178 sides (84.8%); and the obstruction was released with double-J stent indwelling in 169 sides. The mean operation time was 34 min (16-57 min). During the operation,2 cases developed ureteral perforation and 3 had hypovolemic shock. In 17 cases (18 sides),the calculi moved back into the renal pelvis,and thus received a second EWSL. Totally 65 cases (51.2%,65/127) developed gross hematuria,and were cured spontaneously in 1 to 3 days. Conclusions Rigid ureteroscopy can be the first choice for acute obstructive renal failure,for the procedure is safe and minimally invasive,leading to quick recovery. It is applicable to bilateral ureteral obstruction.