Background: Ureteral calculi larger than ten millimeters are likely to impact and have high endoscopic failure rates, suggesting a good indication for primary ureterolithotomy. Aim: This study aimed to assess the results of laparoscopic ureterolithotomy and extracorporeal shock wave lithotripsy (ESWL) in management of large Ureteral Calculi as regards the morbidity and stone free rate. Patients and methods: This prospective randomized research has been performed on 48 cases with large ureteral calculi divided into 2 groups: Group A involved 24 cases that underwent laparoscopic ureterolithotomy and Group B involved the remaining 24 cases that underwent ESWL. The patients were collected from the Outpatient Urology Clinic in Suez Canal University Hospital in Ismailia and from the National Institute of Urology in Cairo from November 2014 till November 2016. Results: After the procedure, statistically insignificant variance was observed among both studied groups regarding fever (p-value equal 0.074) and hematuria. However, the incidence of residual stone significantly increased with ESWL (33.33% vs. 4.2% in laparoscopy – p = 0.01). No mortality was encountered in our study. In the laparoscopic group, transformation to the open technique has been required in three patients (12.5%), and postoperative leakage ranged between 0 and 1600 ml. 1 case had persistent leakage and required DJ stent. Conclusion: Laparoscopy is superior to ESWL in single-session clearance of ureteric stones. Nonetheless, it is associated with longer procedure time, longer hospitalization period, and postoperative urine leakage.