Miller DT, et al. - This research was sought to describe the retrograde use of the Lithoclast, in a dilated distal ureter after the incision of a ureterocele. Researchers describe a case of a 64-year-old female with a large distal ureteral stone burden, with approximately 15 1-2cm stones. The significant right flank pain, urinary urgency, frequency, dysuria, and recurrent urinary tract infections were presented by her. This study's findings demonstrate that the use of the rigid nephroscope and ultrasonic lithotripter in a female patient with a dilated distal ureter with a capacious or incised ureterocele was found to be safe and effective, allowing for treatment of greater than 15cm total distal ureteral stone burden.