Abstract: Objective  To investigate the effect and to determine the best treatment among the three method of retroperitoneal laparoscopic lithotomy(RPLU), lithotripsy with flexible ureteroscope(FURL) and percutaneous nephrolithotomy(PCNL) in the treatment of impacted upper ureteral calculi larger than 1.5 cm. 
Methods  One hundred and fifty-nine cases of upper ureteral impacted calculi were retrospectively analyzed. The preoperative and intraoperative data were collected and the cases were divided into RPLU group(56 cases), FURL group(55 cases) and PCNL group(48 cases) according to different operation style. The operation time, postoperative hospital stay, stone clearance rate and postoperative complications were statistically analyzed. 
Results  The operation time and postoperative hospital stay in FURL group were significantly shorter than those in RPLU group and PCNL group(P＜0.05). The stone clearance rate of RPLU group(100%, 100%) was slightly higher than that of FURL group(90.9%, 94.5%) and PCNL group(93.8%, 93.8%) at 3 days and 1 month after operation, but the differences were not statistically significant(P＞0.05). There were no serious complications in the three groups. 
Conclusion  It shows that the three Methods   are safe and effective in the treatment of incarcerated upper ureteral calculi. The FURL group has the advantages in shorter operation time and hospitalization stay, and the patients recover faster after operation, compared with other two Methods  .

Key words: ureteral calculi； laparoscopy, flexible ureteroscope, percutaneous nephroscopy