Aims: To compare the outcome after flexible ureteroscopic (FURS) laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) for management of patients with upper ureteral calculi up to 2 cm. Study Design: A prospective randomized comparative study. Place and Duration of Study: Tanta Urology Department, Tanta University in Tanta, Egypt between October 2018 to October 2021. Methodology: We included 95 patients (62 men, 33 women) with upper ureteral calculi up to 2 cm. 48 patients underwent flexible ureteroscopic laser lithotripsy while 47 patients underwent extracorporeal shock wave lithotripsy. The outcome including the operative time, the success rate, retreatment rate, auxiliary procedures and complication rates was reported. Results: The complete stone free rate was 95.8% in the FURS group and 72.3% in the ESWL group 1 month postoperatively (P value = <0.002). As regard auxiliary procedures (4.2%) in FURS group and (6.4%) in ESWL group underwent secondary procedures (P value = 0.677). The respective complication rates (evaluated using the Clavien system) were 5.2% in FURS group, and 7.3% in ESWL group (P value = 0.323). Conclusion: FURS affords a comparable success rate than ESWL and seems to be a promising alternative to ESWL when higher stones densities are to be treated. Prospective randomized controlled trials are needed to confirm these findings.