INTRODUCTION: Large impacted upper ureteric calculi management remains challenging for urologist. Extracorporeal shockwave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), Percutaneous nephrolithotripsy (PCNL) and laparoscopic or open ureterolithotomy are the various treatment available. The aim of the present study is to analyze several clinical, intraoperative, and postoperative factors and to compare the efficacy of retrograde versus antegrade URSL for the treatment of large proximal ureteral stones. METHODS: 20 consecutive patients with upper ureteric stones were evaluated. Ultrasonography and intravenous urography (IVU) was performed in all patients before surgery. Patients who underwent APCVL or URSL were included in study and devided into two groups. Stone free rate, mean operative time and fluoroscopy time, complications and hospital stay were assessed. The findings in both groups were compared and statistically tabulated. RESULTS: The two groups were comparable in age, sex, body mass index (BMI). The mean stone size was 15.32 ± 2.24 and 14.82 ± 1.82 mm in groups 1 and 2, respectively. In the Perc‑URS group, 10 patients had complete calculus clearance through a single tract in one session of percutaneous surgery [Table 2]. The mean operative time was 66.05±21.7 min. In the URS group, 7 patients (70%) had complete stone clearance. The remaining patient underwent open ureterolithotomy.The mean operative time was 52.13 ± 17.3 min. Three patients (30%) experienced failure during the procedure[Table 2]. CONCLUSION: Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone–free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.