To explore the curative effect of three minimally invasive surgery on complex proximal ureteral calculi and their influences on renal function and postoperative pain. Methods A retrospective analysis was performed on the clinical data of 97 patients with complex proximal ureteral calculi in the hospital from January 2017 to May 2022. According to different surgical methods, they were divided into retroperitoneal laparoscopic ureterolithotomy (RLU) group (42 cases), mini-percutaneous nephrolithotomy (MPCNL) group (15 cases) and transurethral ureteroscopic lithotripsy (URL) group (40 cases). The perioperative indexes, renal function indexes ［blood urea nitrogen (BUN), lipocalin (NGAL), serum creatinine (Scr)］, pain level and complications before and after surgery were compared among the three groups. Results The operation time in RLU group was longer than that in URL group and MPCNL group, intraoperative blood loss was lower than that in URL group and MPCNL group, hospitalization time was shorter than that in URL group and MPCNL group, and one-time stone clearance rate was higher than that in URL group and MPCNL group (P＜0.05). There was no significant difference in postoperative Scr or BUN among the three groups (P＞0.05). After surgery, level of serum NGAL in RLU group was lower than that in URL group and MPCNL group (P＜0.05). At 1d and 3d after surgery, scores of Visual Analogue Scale (VAS) in MPCNL group were higher than those in URL group and RLU group (P＜0.05). The incidence of complications in RLU group was lower than that in URL group and MPCNL group (P＜0.05). Conclusion RLU, MPCNL and URL can all be applied in the treatment of complex proximal ureteral calculi. Among them, RLU has little intraoperative blood loss, short postoperative recovery time, high one-time stone clearance rate and few postoperative complications, which can protect renal function and is the first choice. MPCNL has more surgical trauma and can be the one-stage operation for patients with ipsilateral nephrolithiasis and ureteropelvic junction stenosis, with long hospitalization time. URL has the mildest postoperative pain, which may be more suitable for patients with pain sensitivity