Objectives To analyse the causes of difficult access during rigid transurethral ureteroscopy and how to manage.Methods From March 2005 to January 2006,182 cases of rigid transurethral ureteroscopy were evaluated retrospectively. Results Twenty four of 182 cases were difficult to perform ureteroscopy,but 10 of 24 cases succeeded with skill.Twelve of 14 cases with ureter stricture or flexura were rendered to dilate satisfactorily,but for the other two, one turned to operation,and one to ESWL with ureter catheter.Conclusions Difficult access into ureter is not rare,we should be familiar with the anatomy of ureter and master the techniques of operation.