Sixty-six symptomatic primary stones in the upper ureter were treated using extracorporeal shock wave lithotripsy (ESWL). All patients underwent preprocedural cystoscopy for stone manipulation and 27 of the patients had the stones dislodged proximally. The stone-free success rate for this group of dislodged stones was 93 per cent. Of 39 ureteral stones treated in situ (impacted), 33 patients were rendered stone-free at three months. Three stones in this group failed to disintegrate and required surgical treatment. Complications of ESWL were minimal. ESWL of upper ureteral stones is an effective noninvasive, noncontact method of treatment. Successful stone manipulation increased the stone-free rate, yet impacted stones disintegrated and passed in 85 per cent of treatments. Lithotripsy of small renal stones prior to migration and proximal ureteral stones early in the symptomatic course may significantly alter the incidence of distal ureteral calculi requiring hospitalization, cystoscopy or ureteroscopy.