Summary : Extracorporeal shock wave lithotripsy has become the preferred method for treatment of most of urinary tract stones incluing lower ureteric stones due to improvement in lithotriptor technology. We have reviewed the charts of all patients who had undergone ESWL in our center for lower ureteral calculi and selected only 179 patients with complete follow-up so that the final result of treatment would be clear either becoming stone-free or undergoing ureteroscopy to remove the original stone or any residual fragments that did not pass spontaneously. Patients were treated on outpatients basis . We did not manipulate the stones prior to ESWL as we believe that if a patient is going to undergo anesthesia for stone manipulation he might as well undergo ureteroscopy and get rid of his stone. These patients had no manipulation whatsoever. Thus these patients were spared cystoscopy, stone manipulation or stent placement. The average stone mass is 21.3 mm. The average number of shocks per session was 4509 shocks at mean energy level 16.2 KV. No anesthesia was used in any of the patients but all of them received analgesia with the use of narcotics and/or tranquilizers. Eighty-five patients (52.8%) were stone free after one session of ESWL. While 47.2% of the patients required two or more sessions of ESWL to become stone free. Our success rate is 89.9%. The 18 patients who were considered failures of treatment by ESWL were due to complete failure of fragmentation of the stone, in 4 patients, persistent steinstrasse in 8 patients. Increasing degree of hydronephrosis on follow-up ultrasonography in 4 patients and development of sepsis and fever in two patients. All the patients were managed successfully with ureteroscopy.