Over the past two decades, the management of upper-tract urinary stones has dramatically changed towards an increase in the use of ureteroscopic treatment. This change has been driven by technological advances such as the creation of flexible ureteroscopes with reduced calibre (which now have digital, disposable and dual flexion capability) and holmium lasers with increased power. Two basic principles exist when treating stones ureteroscopically: either creating stone dust and small fragments (<1-2 mm) to theoretically enable spontaneous passage of the small particles or stone fragmentation that enables safe extraction of the stone pieces with a basket or grasper in an efficient manner. Each method has unique advantages and disadvantages, but, ultimately, surgeon preference, stone size, composition, location and intrarenal and/or ureteral anatomy determine which technique is used. To date, clinical trials comparing these two techniques are lacking.