Objective: To explore the value of early retrograde double J tube drainage and percutaneous nephrostomy drainage in the emergency treatment of ureteral calculi obstruction complicated with urinary sepsis. Methods: The clinical data of 74 cases of ureteral calculi obstruction complicated with urinary sepsis in our urology department from September 2016 to February 2019 were retrospectively analyzed. Forty-four cases were treated with early ureteroscopic retrograde double J-tube drainage under direct vision. They were classified as double J-tube drainage group, and 30 cases were treated with percutaneous nephrostomy and fistula drainage under B-ultrasound guidance. Emergency treatment was recorded as puncture and fistula drainage group. The general information, success rate of drainage, control time of sepsis, complications and stage II lithotripsy were compared between the two groups. Results: There was no significant difference in preoperative data between the 2 groups (P>0.05). The success rate of double J tube drainage group [100.00% (44/44)] was significantly higher than that of puncture and fistula drainage group [80.00% (24/30)]. The difference was statistically significant (χ2=9.577, P<0.05). There was no significant difference in the improvement time of urinary sepsis between double J tube drainage group [(6.49±1.30) d] and puncture fistula drainage group [(6.53±1.29) d; t=0.098, P>0.05]. No ureteral injury, perforation, peripheral organ damage, massive hemorrhage or septic shock occurred in the 2 groups. Phase II lithotripsy was successfully performed after operation, and the recovery was good. Conclusion: Early retrograde double J-tube drainage and percutaneous nephrostomy and drainage are safe and effective in emergency treatment of ureteral calculi obstruction complicated with urinary sepsis. Compared with percutaneous nephrostomy and drainage, retrograde double J-tube drainage under ureteroscope has higher success rate and less technical difficulty. Clinical practice can be selected according to the doctor’s operating experience and the patient's hydronephrosis degree.