Patients randomized to this group will undergo laparoscopic ureterolithotomy under general anesthesia. Prior to the procedure, an X-ray KUB will be performed to confirm the stone location. The patient will be placed in a flank position. Pneumoperitoneum will be created using a Veress needle, and three laparoscopic ports will be placed:

Port I (10 mm, sub-umbilical): for the 30° laparoscope

Port II (10 mm, mid-clavicular, iliac spine level): for stone extraction

Port III (5 mm, subcostal, mid-clavicular): for assistance and retraction

The stone will be identified as a ureteral bulge, confirmed by palpation with an atraumatic grasper. A longitudinal ureterotomy will be performed with a laparoscopic scalpel/L-hook, and the stone will be extracted via Port II. Large stones may be placed in a gloved finger pouch for retrieval at the end of surgery. The ureterotomy will be closed with interrupted 4-0 polyglactin sutures (two or three, depending on size). A 20F Nelaton tube drain will be

Patients randomized to this group will undergo ureteroscopic lithotripsy under general or regional anesthesia. A cystoscopy and retrograde pyelogram will be performed first. A 6/7.5 Fr semirigid ureteroscope will be advanced through the ureteric orifice using a guidewire until the stone is visualized. Pneumatic lithotripsy will then be performed with the following settings:

Energy: 4 bar Frequency: 5 Hz

The stone will be fragmented into pieces <2 mm in size. A stone cone will be used to prevent retropulsion. Ureteric orifice dilatation will be performed if required. A DJ stent will be placed at the end of the procedure and will be removed at 4 weeks postoperatively. Antibiotic prophylaxis will be administered perioperatively.

Keyhole laparoscopic approach to remove proximal ureteral stones by direct ureteral incision and closure.

Operative time will be measured from the start of the surgical procedure until urethral catheterization is completed. The duration will be recorded in minutes for each patient and compared between ureteroscopic lithotripsy and laparoscopic ureterolithotomy groups.

The stone-free rate will be defined as the absence of residual stone fragments >3 mm, confirmed by radiological imaging (X-ray KUB or NCCT) at follow-up. Patients with residual fragments ≤3 mm will be considered stone-free, while those with larger fragments or requiring auxiliary procedures will be considered not stone-free.

Pain intensity will be assessed using a Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (worst pain). Scores will be recorded on the day of surgery and the first postoperative day. Analgesic use (mg dose administered) will also be documented.