Background <p>Laparoscopic ureterolithotomy (LU) is an effective option for managing large or impacted ureteral stones when other minimally invasive treatments are not feasible. However, data on outcomes and predictors of recovery after LU remain limited.</p> Methods <p>We retrospectively reviewed 40 patients who underwent LU at a single center. Clinical features, perioperative parameters, and outcomes were analyzed to identify predictors of prolonged hospitalization and postoperative pain.</p> Results <p>All patients achieved stone-free status, and no major intraoperative complications occurred. The mean hospital stay was 4.6 ± 3.5 days. Multivariate analysis showed that postoperative fever (<i>p</i> = 0.002), prior percutaneous nephrostomy drainage (PCND) (<i>p</i> = 0.009), and longer operative time (<i>p</i> = 0.048) independently predicted prolonged hospitalization. Severe postoperative pain was more likely in patients with preoperative acute kidney injury (AKI) (<i>p</i> = 0.015) and in those treated with the transperitoneal approach compared with the retroperitoneal approach (<i>p</i> = 0.022).</p> Conclusions <p>LU provides excellent stone clearance with minimal complications. Preoperative factors such as PCND and AKI, along with intraoperative choices like surgical approach, influence recovery outcomes. Identifying these predictors may guide perioperative management in LU.</p> Trial registration <p>Not applicable.</p>