Objective: what is the best treatment option for large lower ureteral calculi? Conventional retrograde ureteroscopy is difficult and lengthy. We present a video of our experience with ureteroscopy using a nephroscope for the treatment of large lower ureteral calculi larger than 2 cm or multiple. Materials and methods: since January 2003, we have treated 26 patients presenting large stones of the distal ureter, with retrograde ureterscopy using a nephroscope. The volume of stones was between 2 and 8 cm, in association with an ureterocele in 4 cases and an ectopic ureter in the prostatic urethra just above the Verumontanum in 1 case. Operative technique: under spinal anesthesia, patients are placed in the position of ureteroscopy. Cystoscopy is performed with a 20.8 Fr Wolf nephroscope. After guide wire insertion and dilation to 12 Fr, the central rod of Alken metallic dilators is placed over the guide wire in the ureter just below the stone. The ureteral meatus is gradually dilated by the Amplatz dilators up to 24 Fr, under fluoroscopic guidance. Moreover, in women a 24 Fr Amplatz sheath is placed. Ureteroscopy is performed using the nephroscope until reaching the stone. Fragmentation and extraction is performed with ultrasound. After ureteral exploration, a double J catheter is placed. Results: The identification of the ureteral meatus, dilation, nephroscope progression, and extraction of stones was possible in all cases. Operative time was between 45 and 130 min. the double j stent was removed at 6 months. No patient presented ureteral stricture at postoperative IVU, nor reflux in retrograde cystogram. A reduction in the volume of the sacculation was noted in the ureteroceles patients. Conclusion: Retrograde ureteroscopy using a nephroscope was possible and allowed an extraction of a larger stone burden in a very short time compared to conventional ureteroscopy. In addition, No complication was noted.