Purpose <p>To compare the safety and efficacy of percutaneous laser ablation and radical nephroureterectomy for renal pelvic tumors.</p> Methods <p>This prospective cohort study included 30 patients diagnosed with renal pelvic tumors who met the established selection criteria. The cohort was divided into two groups: Group I, consisting of 15 patients who underwent percutaneous laser ablation, and Group II, comprising 15 patients who received radical nephroureterectomy. Comprehensive data collection encompassed demographic information, intraoperative and postoperative outcomes, and disease-free survival.</p> Results <p>The analysis revealed that percutaneous laser ablation offered modest benefits over radical nephroureterectomy in terms of reduced surgical duration (<i>P</i> &lt; 0.01) and shorter hospital stays (<i>P</i> = 0.03). However, in evaluating long-term oncologic outcomes, percutaneous laser ablation did not achieve parity with radical nephroureterectomy. Although the differences in long-term outcomes were not statistically significant (HR: 0.48; 95% CI 0.05–4.92, <i>P</i> = 0.54), radical nephroureterectomy exhibited a slight advantage in disease-free survival.</p> Conclusion <p>Percutaneous laser ablation presents a safe and effective, less invasive treatment alternative, rendering it a feasible option for patients who are either unable or unwilling to undergo radical nephroureterectomy due to comorbid conditions or personal preferences.</p>