Objective To evaluate the clinical effect of pneumatic lithotripsy under ureterorenoscope in the treatment of ureteral calculi. Methods One hundred and eighty-nine cases of ureteral calculi were treated by ureterorenoscopic pneumatic lithotripsy between November 1999 and February 2003. Results Lithotripsy was performed successfully on one session in 183 cases,with a success rate of 96.8% (183 of 189).Conversions to open surgery were required in the remaining 6 cases because of unsuccessful entry of the ureterorenoscope (ureteral perforation in 1 case).Follow-up period ranged from 10 days to 3 months (mean, 1.3 months). Stones were entirely expelled in 182 cases of the 183 cases (99.4%) within 2 months after the procedures. Conclusions With minimal invasion and pain, this procedure is safe and effective for ureteral calculi, being probably the treatment of first choice.