The choice of technique for the management of a ureteral stone will ultimately depend on the skill of the operator and the availability of technology. Individuals in major medical centers would do well to realize that there are more than 5 billion people on the planet and that less than 1 billion will have the means of access to ESWL in the foreseeable future. How few have access to a skilled ureteroscopist is unknown. It is therefore probable that in the world today, despite the advances in technology, ureterolithotomy continues to be the commonest procedure performed for upper, middle, and lower ureteral calculi.