Background: Although ESWL is considered safe for upper ureteric stones, the use of JJ stents may influence complication rates and patient morbidity. Objective: To assess the outcome of ESWL for upper ureteric stones with or without Double-J stent. Methods: In this prospective comparative study, 62 patients with upper ureteric stones were randomly allocated into stented (n=31) and non-stented (n=31) groups. Post-procedural complications including ureteric colic, steinstrasse, fever, suprapubic pain, and LUTS were recorded and analyzed. Results: Ureteric colic was significantly lower in the stented group compared to the non-stented group (12.9% vs 35.5%; p<0.05). However, suprapubic pain was significantly higher in the stented group (41.9% vs 16.1%; p<0.05). The incidence of steinstrasse and fever did not differ significantly between groups (p>0.05). Lower urinary tract symptoms were significantly more common in the stented group, including urinary frequency (48.4% vs 9.7%; p<0.01), urgency (54.8% vs 16.1%; p<0.01), and dysuria (61.3% vs 19.4%; p<0.01). Gross haematuria did not differ significantly between groups. Conclusion: Although JJ stenting reduces ureteric colic after ESWL, it is associated with significantly higher lower urinary tract symptoms and patient discomfort. Routine pre-ESWL stenting is therefore not recommended in uncomplicated upper ureteric stones ≤2 cm.