BACKGROUND AND PURPOSE Most patients with ureteral calculi that do not pass spontaneously can be treated by either extracorporeal shockwave lithotripsy (SWL) or ureteroscopy. In rare cases of large, hard and chronically impacted stones, or after failure of first-line treatments, surgical ureterolithotomy is still indicated. Laparoscopy allows performing this procedure in a minimally invasive manner. PATIENTS AND METHODS Twenty-four patients (22 men and 2 women) underwent laparoscopic ureterolithotomy between 1994 and 1999. The procedure was indicated in 10 cases as a salvage treatment after failure of SWL (5 patients), ureteroscopy (2 patients), both (1 patient), laparoscopic ureterolithotomy (1 patient), or even open ureterolithotomy (1 patient), and in 14 patients as a primary treatment for large stones (median size 11.5, range 8-33 mm). The first 3 procedures were carried out via the retroperitoneal route and the following 21 via the transperitoneal approach. RESULTS All but 1 stone were successfully removed in a mean operating time of 111 (range 45- 180) min. Postoperative pain was managed with first-line analgesics. Hospital stay ranged from 2 to 10 (mean 3.8) days. The 2 postoperative complications encountered were prolonged ileus (1 patient) and venous thrombosis (1 patient). CONCLUSIONS Laparoscopic ureterolithotomy is a safe and effective procedure that enables the urologist to maintain a minimally invasive strategy when first-line treatment have failed or are unlikely to be effective.