Background: The open method of surgically removing kidney stones has been radically replaced by less intrusive minimally invasive methods since the advent of shock-wave lithotripsy (SWL) and subsequent technological developments in endoscopic techniques, such as ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL). Objective: We aimed to delineate Ideal treatment modality for large upper ureteral stones. Subjects and methods: A 47 years married male heavy worker and heavy smoker patient presented with right loin pain with hematuria 7 days ago increasing with time responded to NSAIDS. Management done using Ureteroscopy and percutaneous nephrolithotomy. Results: Symptoms started with right loin pain and hematuria, with recent dysuria ultrasound showed bilateral back pressure. Urine analysis showed microscopic hematuria and creatinine was 2.2. Non-contrast CT showed right lower ureteric stone and left upper ureteric large stone and multiple sizable left renal stones and we removed all stones with our technique. Conclusion: Push back of large upper ureteral stones and retrieval percutaneously using nephoscope was a good option specially if associated with renal stones with large burden.