Objectives <p>This study presents the first systematic review and meta-analysis assessing the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on the clinical outcomes in individuals with ureteral stones.</p> Methods <p>Relevant studies were systematically identified through searches in PubMed, Embase, Web of Science, and Cochrane, covering publications up to January 2025, focusing on studies that assessed the predictive role of NLR in the clinical outcomes of individuals with ureteral stones. Outcomes included spontaneous stone passage (SSP) and ureteric sepsis. Predictive data for SSP were derived from a cohort of patients receiving conservative medical treatment, while predictive data for ureteric sepsis were derived from a cohort of patients receiving surgical treatment. Sensitivity and subgroup analysis were conducted to evaluate the stability of the results and possible sources of heterogeneity.</p> Results <p>10 cohort studies involving 4,859 patients with ureteral stones were analyzed in this meta-analysis. The meta-analysis of multivariate data showed that SSP rate was significantly lower in the high NLR group compared to the low NLR group (OR: 0.46; 95% CI: 0.33, 0.64; <i>P</i> &lt;0.00001), and the risk of ureteric sepsis in the high NLR group was significantly higher than that in the low NLR group (OR: 2.50; 95% CI: 1.31, 4.76; <i>P</i> = 0.005). Subgroup analysis suggested that the prognostic value of NLR for patients with ureteral calculi was not affected by stone size and NLR cut-off value.</p> Conclusions <p>NLR can be used as an independent predictor of the SSP and the risk of ureteric sepsis in patients with ureteral stones. Future large-scale, multicenter, prospective clinical studies are necessary to further confirm the relationship between NLR and the clinical outcomes of patients with ureteral stones.</p> Clinical trial number <p>Not applicable.</p>