Abstract: Objective To investigate the clinical effects of low-pressure reflux irrigation on stone residue and thermal injury during ureteroscopic holmium laser lithotripsy. Methods A total of 152 patients with middle and upper ureteral stones were divided into an observation group and a control gronp (n=76). Both groups underwent laser lithotripsy. The control group received conventional ureteroscopic holmium laser lithotripsy. In contrast, in the observation group, a 4F catheter was first inserted above the stone, which was placed outside the scope, and then the scope was reinserted to the stone site. The observation group used the hanging bag method (with a height of 95 cmH₂O) for continuous irrigation during the holmium laser lithotripsy. The surgical time, stone clearance rate, residue rate, postoperative fever, and incidence of ureteral stricture were observed in both groups. Results The average surgery duration for the observation group was 30 min, and the stone clearance rate was 97.4%. There were 2 cases (2.63%) of stone migration residue, 2 cases (2.63%) of postoperative fever, and 1 case (1.3%) of ureteral stricture. The differences between the two groups were statistically significant (P<0.05). Conclusions During ureteroscopic holmium laser lithotripsy, low-pressure reflux irrigation for middle and upper ureteral stones results in a high stone clearance rate and a low stone residue rate, with fewer complications, making it a promising method for clinical application.