Objective: To compare the outcomes of pneumatic lithotripsy versus holmium laser in distal ureteric stones Study Design: Cross sectional study Setting & Duration of Study: The study was conducted at department of Urology in Sindh Institute of Urology and Transplantation (SIUT) Karachi. Six months. Since 1st July 2020 till 31st December 2020. Method: 208 patients who underwent Pneumatic Lithotripsy and Holmium Laser in Distal ureteric stones were selected for the study, who were randomized into 2 groups of 104, in each group the success rate in the pneumatic group and in laser group is calculated. Outcomes were assessed in terms of intra-operative time period, stone migration, need for stent placement, hospital stay and stone clearance. Results: There were total 208 cases of mean age of 37.15±9.14 years. When they were evaluated for stone size mean size of stone was 8.9±2.24mm of which the mean stone size of pneumatic lithotripsy was 8.50±2.21 and in the Ho: YAG laser group was 9.13±2.22. On comparison, it was noted that pneumatic lithotripsy was effective in 65 (62.5%) and Ho: YAG laser in 89 (85.57%) with a statistically significant difference (p< 0.06). On stratification, it was noted that there is no significant impact of age on the efficacy of the treatment. Ho: YAG laser was effective in 71 (79.77%) in age group <30 and showed the results of Ho: YAG laser 18 (20.22%) in >40 year of age. But there was significant difference for the size of stone in the treatment groups with a p-value of <0.05 as significant. Conclusion: Outcomes are better in patients of ureteric stones having laser lithotripsy as compared to the patients having pneumatic lithotripsy. Keywords: Pneumatic lithotripsy, Laser lithotripsy, ureteric stone