The purpose of this study is to compare the efficacy of ureteroscopy (URS) and internal ureteral stents in treating urolithiasis in pregnant women. Systematic literature searches of MEDLINE, EMBASE, Web of Science, and the Cochrane Library were used to identify relevant studies published between January 1980 and June 2022. There were initially 499 identified studies. Women in any trimester of pregnancy who had ureteroscopy or double-J (D-J) stent insertion for urolithiasis were considered; studies had to have 10 or more participants to be included. The PROSPERO database has been updated to include this systematically compiled study (Reference: CRD42020195607). About 25 trials were found, with 131 patients getting serial stenting and 789 patients undergoing URS. Both D-J stent insertion and URS had a pooled surgical success rate of 97%. After many D-J stent placements, only a small percentage of patients passed stones independently. Overall, URS’s stone-free rate (SFR) was at 91%. The success rate for IUS therapy was 99%, whereas problems occurred in about 45% of patients. The normal fertility outcome rate for the URS therapy group was 99%, with the overall complication rate being around 1%. However, there was no significant difference in the rates of serious problems, preterm birth, or abortion when comparing the 2 groups (<1%). In treating pregnant women with symptomatic urolithiasis, ureteroscopy and internal ureteral stents exhibited modest rates of unfavorable effects on reproductive outcomes, while internal ureteral stents may cause mild problems. According to the available data, if performed correctly, URS may be more beneficial for pregnant individuals with urinary stones. Internal ureteral stents have been shown to be safe and effective. Therefore, they may be considered in an emergency or other unique circumstances.