Background: The third-highest rate of all urinary issues is urinary stone illness. Patients with stones less than 5 mm have a 68% spontaneous passage rate, while patients with stones larger than 6 mm have a very low spontaneous passage rate of 5%. The aim of the present study was to assess the difference between complete retrieval of small stone gravels versus spontaneous passage of these gravels after uretroscopic lithotripsy as regard intraoperative and postoperative complications and stone clearance. Patients and methods: A randomized controlled clinical trial was carried out at Urology department, Al-Azhar University Hospital between February 2021 and August 2021. It included 60 patients with lower ureteric stones admitted to the Urology Department for endoscopic management. Results: Patients who underwent intraoperative fragment retrieval had significantly longer operative time in comparison to those underwent spontaneous fragment expulsion (57.53 ± 15.13 vs. 34.90 ± 8.14 minute; p < /em><0.001). Operative time ranged between 36 and 88 minute in case of fragment retrieval and between 25 and 54 minute in case of spontaneous fragment expulsion. Only 2 (6.7%) patients from those underwent spontaneous fragment expulsion and 5 (16.7%) patients from those underwent intraoperative fragment retrieval developed intraoperative complications with no significant differences (p < /em>=0.21). Conclusion: Ureteroscope has been safe and efficient in managing ureteroscopy, leaving gravels 3 mm or less after uretroscopic lithotripsy is associated with mild post-operative symptoms as abdominal pain, burning micturition but less operative time, less complication of anaesthesia, less operative cost less effort from surgeon and less intraoperative complication, so that this method is advisable.