Abstract: Objective To study the risk factors of urosepsis after ureteroscopy with holmium laser lithotripsy. Methods The clinical characteristics(age,gender,rate of positive urine culture before the operation,diabetes mellitus,polyp,diameter of stone,and operation time) of 399 ureteral calculus patients undergoing ureteroscopic holmium laser lithotripsy in our hospital between June,2011 and June,2015 were retrospectively analyzed.Among them,23(5.76%) suffered urosepsis.There were 14 female patients(11 cases were in perimenopausal stage) and 9 male patients.The mean age was 50.8±16.5 years(range 39-78 years).The mean operative time was 62.8±23.5 min(range 47-197 min).The urine culture of 16 patients were positive,including gram-negative bacteria Escherichia coli in 11 cases,Klebsiella pneumonia in 2 cases,gram-negative bacteria staphylococcus aureus in 2 cases and staphylococcus epidermidis in 1 case.All patients need not blood transfusion.The chi-square test and a logistic regression model were used to identify key risk factors. Results In univariate analysis,the significant associations were observed between advanced age(≥ 70 years),female gender,diabetes,positive urine culture,operative duration>60 min and sepsis after ureteroscopic holmium laser lithotripsy(all P<0.05).But polyp and stone diameter were insignificant for urosepsis(both P>0.05).While in multivariate analysis,female gender,diabetes,positive urine culture,operative duration>60 min were identified as independent risk factors for urosepsis after ureteroscopy with holmium laser lithotripsy(all P<0.05). Conclusion Female gender,diabetes,positive urine culture,operative duration>60 min are the key risk factors of urosepsis after ureteroscopy with holmium laser lithotripsy.