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Purpose Primary Ureteroscopy & Laser Lithotripsy is the treatment of choice for distal ureteral stones. However, in cases of proximal ureteral stones some urologists recommend preliminary insertion of a Double J ureteral stent (DJS) and deferred Ureteroscopy. We aim to evaluate the necessity of preliminary DJS insertion in proximal ureteral stones management, by comparing the surgical outcome of patients undergoing primary ureteroscopy and laser lithotripsy for proximal Vs. distal ureteral stones. Patients and Methods Medical records of patients who underwent ureteroscopy between January to December 2016 in our institution were reviewed. Data collected included: demographic data, stone size, renal function, intra and post-operative complications, stone free rate (SFR). Patients were divided into 2 groups: Proximal ureteral stones and Distal ureteral stones. Results This cohort included 241 patients who underwent ureteroscopy, among them 106 had a proximal ureteral stone. Median age was 51 years. Patients who underwent ureteroscopy for proximal ureteral stone were significantly older: 54.68 vs.49.2 (p = 0.007). The median stone maximal diameter was 7 mm, the proximal ureteral stones were larger with borderline statistical significance (p = 0.07). The complication rate and stone free rate (SFR) was similar among both groups (p = 0.657 and p = 1, respectively). The Prevalence of post procedural DJS insertion was higher among patients who underwent ureteroscopy for proximal ureteral stone: 92.5% Vs. 79.3% (p = 0.004). Conclusions Our study concludes that primary ureteroscopy and laser lithotripsy for proximal ureteral stones is a valid and feasible treatment with similar surgical outcome compared to distal ureteral stones. Preliminary DJS insertion seems to be unnecessary.