Objective  To evaluate the outcomes of minimally invasive percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy lithotripsy (F-URL) for upper ureteral calculi.Methods  From January 2011 to March 2014,120 patients withupper ureteral calculi (diameter>1.5) were included.These patients were divided into two groups. Minimally invasive percutaneous nephrolithotomy (mPCNL) was performed in 70 patients and flexible ureteroscopy lithotripsy (F-URL) was performed in 50 patients.All these patients included light and moderate hydronephrosis group (68cases),severe hydronephrosis group (42 cases). The following parameters of F-URL were compared with the mPCNL: postoperative hospitalization time,complications,one-time stone clearance rate,blood loss (the decline of hemoglobin before and after operation) ,and operative time.Results  There is no significant difference between the groups of F-URL and mPCNL in one-time stone clearance (P> 0.05),While The mean postoperative hospital days was shorter in the group of F-URL than the group of mPCNL in the 120 cases (P<0.05) ;The postoperative hemoglobin decrease was less in the group of F-URL than the group of mPCNL in the cases with light,moderate hydronephrosis (P<0.05) ; The postoperative hemoglobin decrease was almost the same in the groups of F-URL and the group of mPCNL in the cases with severe hydronephrosis .The operative time was shorter in the group of F-URL than the group of mPCNL in the cases with light or moderate hydronephrosis (P<0.05),while the operative time was longer in the group of F-URL than the group of mPCNL in the cases with severe hydronephrosis (P<0.05).Conclusion  (1) Both F-URL and mPCNL are effective and safe treatment for complicated upper ureteral calculi (diameter>1.5cm) .(2) For those patients with light and moderate hydronephrosis,the F-URL is a safe and effective treatment.(3) For those patients with sever hydronephrosis,mPCNL is one of the best choice.