Objective To explore the application value of three-dimensional reconstruction technology of CT urography (CTU) in the diagnosis and location of urinary calculi. Methods: 102 patients with highly suspected urinary calculi who visited our hospital from January to December 2024 were collected as the research subjects. All patients underwent B-ultrasound examination and CTU three-dimensional reconstruction technology examination respectively. And take the comprehensive clinical diagnosis result as the gold standard for diagnosis. To analyze the value of three-dimensional reconstruction of CTU in the diagnosis and location of urinary calculi. Results Among the 102 patients with highly suspected urinary system stones, 82 cases were eventually diagnosed with urinary system stones. Among them, 49 cases were simple kidney stones, accounting for 59.76%, 22 cases were simple ureteral stones, accounting for 26.83%, and 11 cases were kidney stones combined with ureteral stones, accounting for 13.41%. Based on the clinical diagnosis results, the detection rates of urinary calculi by B-ultrasound and three-dimensional reconstruction of CTU were 81.71% (67/75) and 92.68% (76/82), respectively. The sensitivity, accuracy rate and negative predictive value of three-dimensional reconstruction diagnosis of CTU were significantly higher than those of B-ultrasound examination (P < 0.05), and the consistency with clinical diagnosis results was significantly higher than that of B-ultrasound examination, with a K value of 0.700 (P < 0.05). Conclusion: The three-dimensional reconstruction technology of CTU has high sensitivity and accuracy in the diagnosis of urinary calculi, and has good consistency with the clinical diagnosis results.