Background: Pneumatic lithotripsy (PL) and Holmium:YAG laser lithotripsy (LL) are two valid mini-invasive approaches in the treatment of urologic stones disease. The aim of this study was to compare stone free rates between these two treatment options.Material and methods: From January 2010 to January 2011, 120 consecutive patients with single and primary ureteral stones were prospectively enrolled in this prospective study. The study was single-blinded and none of the patients knew which approach for stone fragmentation would be used.Results: The ureteral stone-free rate (SFRs) in the PL group was 80.7% and 86.1 % in the LL group (p=0.002). The mean operating time was 60 (+ 25) minutes in the LL group and 61 (+ 21) minutes in the PL group, without significant differences (p=0.68). Multivariate logistic analysis revealed that stone location was not significantly predictive of SFRs (p=0.47). None of the patients had blood transfusions and no other severe complications appeared in either group.Conclusions: In our study LL was significantly associated with a stone 80.7% in the PL group and 86.1% in the LL group (p<0.05). Also, Holmium:YAG laser lithotripsy was demonstrated to be the more efficacious endoscopic procedure for the treatment of ureteral stones, allowing stones to be successfully fragmented, with few complications.