Abstract： Objective To explore the risk factors for failure in unilateral upper ureteral calculi treated with ureteroscopic holmium laser lithotripsy.Methods Totally 852 patients with upper ureteral calculi treated by rigid ureteroscopy holmium laser lithotripsy were retrospectively chosen in Inner Mongolia People's Hospital from January 2012 to September 2021 were enrolled,including 72 cases with lithotripsy failure evaluated a week after operation(lithotripsy failure group),and other patients with lithotripsy success(lithotripsy successful group).The clinical characteristics were analyzed and the independent risk factors of lithotripsy failure were evaluated by multivariate Logistic regression methods.Results The proportions of stones located on the left side,multiple stones,difficulty in entering the endoscope and stone dwell time ≥ 6 weeks in the lithotripsy failure group were higher than those in the lithotripsy successful group;the CT value of stones and stone dwell time≥2 weeks in the lithotripsy failure group were lower than those in the lithotripsy successful group(all P＜0.05).The multivariate Logistic regression analysis showed that difficulty in ureteroscopy was an independent risk factor for the failure of ureteroscopic holmium laser lithotripsy(odds radio=2.64,95％confidence interval:1.75-3.64,P=0.02).Conclusion The success rate of ureteroscopic holmium laser lithotripsy for the treatment of unilateral upper ureteral stones is high,and difficulty in entering the ureteroscope is an independent risk factor for lithotripsy failure.