The clinical and pathological findings in a 42-year-old female with bilateral ureteral polyps associated with chronic inflammation, dysplasia, and urolithiasis were presented and discussed along with the literature. Urolithiasis was detected in the patient who had initially applied to another centre with bilateral flank pain; the ureteroscopy had revealed bilateral ureteral polyps; and the pathological diagnosis of biopsy specimen was in situ urothelial carcinoma. She had a history of smoking 1 package of cigarettes/day for 22 years. Cystoscopy and bilateral ureteroscopy were performed in our clinic. No pathologic finding was detected in cystoscopy, but a 3-cm polyp in the distal right ureter lumen and another polyp filling the left ureter almost completely from the mid to distal part were observed in the ureteroscopy. Biopsies were taken from the polyps with additional selective urine samples from the ureter. The pathological evaluation revealed chronic ureteritis and mild urothelial dysplasia, and the selective urinary cytological examinations were reported as benign. The immunohistochemical evaluation demonstrated increased cyclooxygenase-2 (COX-2) expression of the polyps. The present case showed that ureteral polyps may be detected in patients with urolithiasis. Although these lesions are usually benign, they may be pathologically misdiagnosed as malignant. The malignant potential of these lesions is not known, particularly in patients with long-term smoking history as in our case. Inflammation may be associated with these lesions and an increased COX-2 expression may be detected.