Objectives: To assess the conversion rate during fluoroless-URS and evaluate the feasibility, safety, and efficacy of fluoroless-URS as a definitive management of distal ureteral calculi. Material and methods: Between May 2013 and August 2015, patients with radio-opaque distal ureteral calculi of ≤ 1cm in size were randomized to undergo fluoroless-URS or standard URS. Patients with previous ureteral surgery, ureteral kinking, ureteral stricture, single kidney, additional proximal ureteral or renal calculi, uncontrolled coagulopathy, and/or congenital anomalies of the urinary tract were excluded. Patients’ demographics, stone characteristics, operative data, stone free status, and complications were compared between both groups. Results: Seventy-four cases in the fluoroless-URS group were compared with 80 cases in the standard-URS group. There was no significant difference in the baseline characteristics between both groups in terms of the mean patient’s age (28.8±13.3 vs. 29.5±14.6 years; p=0.76), body mass index (28.2±33 vs. 27.6±2.3 kg/m2; p=0.19), and stone size (7.2±1.5 vs. 7.3±1.7 mm; p=0.70), respectively. Furthermore, there was no significant difference in the outcome parameters between both groups in terms of operative time (42.4±8.3 vs. 40.3±6.5 min; p=0.08), stone free rate (93.2% vs. 95%; p=0.06), and overall complications (12.2% vs. 8.75%; p=0.08), respectively. There was significant difference between both techniques in terms of fluoroscopy time (p