Urolithiasis ,is one of the most common urological diseases; need active management because its high prevalence, various complications and high recurrence rates. There are a lot of techniques for the management, that is, complete stone clearance with little patient morbidity, of ureteral stones. The most commonly used techniques include ureteroscopy (URS), shock wave lithotripsy (SWL) ,percutaneous nephrolithotomy and open ureterolithotomy. Objective: Prospective study to compare the efficacy and safety of the extracorporeal shock wave lithotripsy (SWL) and ureteroscopy with Holmium: YAG laser lithotripsy (URSL) as a management of impacted stone in the upper ureter. Patients and Methods: A total of 100patients with a single impacted stone in the upper ureter were included in the study. Patients were allocated into two groups according to patient preference for either procedure. The first group included 54 patients who were treated by SWL and the second group included 46 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed Results: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.6±1.8vs. 1.05±0.13session, and 40.7% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80.4% vs. 70.3%respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (84.8%vs. 81.5%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (20.4% vs. 15.2%, respectively). We did found a difference in treatment times between the two groups . In the SWL groups, was 25.6±10.0 minute versus 42.5±12.2 minute in the URSL group. Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the upper ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.