Objective To analyze the related factors of recurrence after holmium laser lithotripsy in patients with middle and lower ureteral calculi and construct a predictive model. Methods: The clinical data of 163 patients with middle and lower ureteral calculi admitted to our hospital from January 2022 to January 2024 were retrospectively collected. All patients received holmium laser lithotripsy treatment and were followed up for one year. Taking the re-formation of calculi in the middle and lower ureters confirmed by imaging as the recurrence criterion, the patients were divided into the recurrence group and the non-recurrence group according to the recurrence situation. The baseline data of the patients were collected and compared. The related factors of recurrence after holmium laser lithotripsy in patients with middle and lower ureteral calculi were analyzed through univariate analysis and multivariate Logistic analysis. A predictive model was constructed and the receiver operating characteristic (ROC) curve was drawn to analyze its predictive value for the related factors of recurrence after holmium laser lithotripsy. Results: All 163 patients with middle and lower ureteral calculi received holmium laser lithotripsy treatment. The patients were followed up for one year after the operation. Among them, 51 patients with stone recurrence were included in the recurrence group. There were 112 cases in the non-recurrence group of stones and they were included in the non-recurrence group. There were significant differences in body mass index, diabetes, creatinine, white blood cell 3+ in urine routine, and stone composition between the non-recurrence group and the recurrence group (P<0.05). The results of multivariate Logistic analysis showed that elevated body mass index, diabetes, elevated creatinine, 3+ white blood cells in urine routine, and non-calcium oxalate stone composition were risk factors for recurrence after holmium laser lithotripsy in patients with middle and lower ureteral stones (P<0.05). The above factors were included in the prediction model: logit (P) =-7.264+ elevated body mass index ×0.895+ diabetes ×0.826+ elevated creatinine ×0.875+ 3+×0.746 in urine routine white blood cells + non-oxalate calcium in stone composition ×0.621. The predictive ROC curve was plotted. The results showed that when logit (P) >3.44, the area under the curve (AUC) was 0.912, the diagnostic sensitivity was 85.58%, and the specificity was 89.76%. Conclusion: The factors related to recurrence after holmium laser lithotripsy in patients with middle and lower ureteral calculi include elevated body mass index, diabetes, elevated creatinine, 3+ white blood cells in urine routine, and non-calcium oxalate component of the calculi. Based on this, a predictive model can be constructed to provide a basis for clinical prevention and treatment.