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Metabolic syndrome, such as obesity and hyperglycemia, are associated with kidney stones, and there is an association between body mass index (BMI) and urolithiasis. Treatment of urinary calculi in obese patients is not rare, but radiography images are often unclear. Here we report a case of a morbidly obese patient (BMI, 54 kg/m2) with a ureteral stone, who successfully underwent transurethral ureterolithotripsy (TUL). A 40-year-old man with gross hematuria visited a local doctor, and abdominal computed tomography (CT) showed a left kidney stone. He was admitted to another hospital, and abdominal CT showed a left ureteral stone. However, extracorporeal shock wave lithotripsy (ESWL) and TUL could not be performed because of poor quality radiography images. He was then admitted to our hospital for treatment. A left ureteral stent was placed 6 days before surgery. We successfully performed TUL using an operation table having a relatively high maximum load limit and using a high-voltage C-type arm radioscopy device. The findings in our case suggest that TUL can be successfully performed in morbidly obese patients by using appropriate operative tools.