To investigate the difference and relative advantages between minimally invasive percutaneous nephrolithotomy (MPCNL) in supine position and flexible ureteroscopy (FURS) in the management of surgically indicated single large stone in the proximal ureter.

Patients with single large stone in the proximal ureter with slight to moderate hydronephrosis were prospectively selected and assigned into groups of MPCNL and FURS on the basis of the patient's choice. Demographic data, operative duration, postoperative hospital stay, complication rate, and stone-free rate were recorded and compared.

From October 2010 to May 2012, 76 such patients were consecutively included into the study. No significant difference was found in preoperative demographics, including age, sex, and severity of hydronephrosis. Stone size was 15.6 ± 2.5 and 14.9 ± 2.3 mm (P = .349), operative duration 49.3 ± 11.7 and 67.2 ± 17.3 minutes (P <.001), postoperative hospital stay 4.2 ± 1.1 and 1.8 ± 0.8 days (P <.001), stone-free rate (residual ≤3 mm) 93.7% and 84.1% (P = .198), and complication rate over grade II (modified Clavien system) 12.5% and 6.8% (P = .398) in MPCNL and FURS groups respectively.

Both MPCNL in supine position and FURS are effective and safe surgical options for patients with single large stone in the proximal ureter, when indicated. FURS is associated with faster recovery and less invasiveness than MPCNL in supine position.