目的　分析 4 6例输尿管结石患者在ESWL失败后改行钬激光碎石治疗的原因。方法　 4 6例输尿管结石ESWL 116次 ,平均为 2 .5次。结果　钬激光碎石术 ,术中发现多数结石不同程度粉碎 ,部分结石嵌顿或粘附在输尿管黏膜表面。结论　输尿管结石在ESWL之前应慎重评估 ,中下段结石首选输尿管镜治疗 ,上段输尿管结石 ,特别是并发明显肾积水 ,结石停留时间过长、结石过大者 ,不宜采用ESWL治疗。输尿管结石经ESWL治 2 ,3次 ,若结石不能有效排出 ,应尽改行输尿管镜下钬激光碎石术。 Objective To analyze the causes of the treatment of holmium laser lithotripsy in 46 patients with ureteral calculi after failure of ESWL. Methods 46 cases of ureteral calculi ESWL 116 times, an average of 2.5 times. Results holmium laser lithotripsy, intraoperative findings most of the stones crushed to varying degrees, some stones incarcerated or adhered to the ureter mucosal surface. Conclusions Ureteral calculi should be carefully evaluated before ESWL. Ureteroscopic ureteroscopy is the first choice in the middle and lower calculi. Ureteral calculi in the upper ureter, especially in patients with overt hydronephrosis, excessive stone retention and calculi, should not be treated with ESWL. Ureteral calculi by ESWL rule 2, 3 times, if the stones can not be effectively discharged, should be done under ureteroscopic holmium laser lithotripsy.