The purpose of the study is to evaluate the efficacy and safety of shock wave lithotripsy (SWL) using sciaticum majus foramen and sciaticum minus foramen as the path to treat distal ureteral stone in supine position. Between December 2006 and November 2008, 243 cases of distal urinary calculi were treated in our department using SWL or ureteroscopy. 189 cases for SWL were treated in supine position. The shockwave target on the stone in distal ureter via sciaticum majus foramen and sciaticum minus foramen, avoiding the sacroiliac joint. 54 cases were underwent ureteroscopy combined with holmium:YAG laser lithotripsy. The stone-free rate and the efficacy quotient (EQ) for SWL and ureteroscopy was 81.5%, 0.68; 94.4%, 0.78; respectively (p = 0.02). The retreatment rate for SWL and ureteroscopy was 14.6%, 0, respectively. The number of the shocks ranged from 600 to 3,000 (mean 2,566.3 ± 378.8). The energy per pulse of SWL ranged from 8 to 12 kV (mean 10.7). SWL in the supine position using sciaticum majus foramen and sciaticum minus foramen as the path is a choice of the treatment of distal ureteral stones with an excellent success rate and low side effect.