Objective. To evaluate the clinical outcome of flexible ureterorenoscopy (F-URS) with holmium laser in managing renal stone greater than 2？cm. Patients and Methods. Records of 120 patients (123 renal units) with renal stone greater than 2？cm who underwent F-URS with holmium laser iwere evaluated. The mean stone size was 26.3？mm. Patient and stone characteristics, perioperative outcomes and complications were evaluated. The outcome was determined at 4 weeks on plain radiograph (KUB) and Non-contrast CT scan (NCCT). Follow-up visit was up to 6 months to evaluate the clinical outcome and patients symptoms. Results. Stone burden was an independent predictor of FURS results. After first session of treatment, success rate was obtained in 72 renal units (58.5%). On the other hand, significant residual fragment was encountered in 51 renal units (41.5%). This was improved with “staged-therapy” to 87% and 96.7% after second and third session of treatment, respectively. Complications were recorded. They were managed in proper manner accordingly. Conclusion. This is an attractive, safe and effective technique. It is an ideal option for low volume complex stone with average burdens of 2 to 3？cm. Patient should be informed and consented about staged-therapy. 1. Introduction PCNL has been the standard treatment for renal stone greater than 2？cm [1, 2]. Some authors reported that PCNL stone-free rate is ranging between 77% and 94% [3, 4]. Extracorporeal shock wave lithotripsy (ESWL) for large renal stone renders Stone free (SF) in 51.6% to 57% [5]. Combined ESWL with “RIRS” associated holmium laser were described in comparable results to PCNL [6]. Since Dretler in 1994 [5] described “staged therapy” of F-URS in complex renal stone management, flexible endoscopes underwent great advances in miniaturization as well as durability improvement [5, 7–12]. Many authors reported high success rate between 77% and 92%, minimal morbidity, and short hospital stay of this technique [13–17]. Mariani used electrohydraulic lithotripsy (EHL) in combined with holmium laser reporting promising results with SF rate up to 92% after 2 to 4 sessions of treatment [15]. Holmium laser fiber was used to achieve high stone clearance rate by turning urinary stone into dust, which was eliminated with irrigation fluid [9, 11, 18]. Patients had minimal requirement of pain analgesics and consequently a short hospital stay [19, 20] compared to those patient who were underwent PCNL for almost same burdens of renal stone. 2. Patients and Methods We reviewed medical records of 120 patients (123 renal
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