Objective  To investigate the feasibility and efficacy of modified supine lithotomy for upper ureteral calculi. Methods  From October 2015 to October 2016, a total of 45 cases with upper ureteral calculi underwent holmium laser lithotripsy by a ureteroscope in a modified supine lithotomy. Results  All 45 cases were successfully implantedwith ureteroscope, and lithotripsy success rate was 88.9% (40/45). Stones went into  kidney in 5 cases, and 3 of which were indwelled successfully with D-J tube and given extracorporeal shock wave lithotripsy (ESWL) after operation, and 2 of which successfully finished the surgery by putting up the kidney. Conclusions  Modified supine lithotomy in the treatment of upper ureteral calculi by a ureteroscopy is a safe, effective position, and with higher stone free rate.