ABSTRACT INTRADUCTION: RIRS and PCNL are the two most commonly used methods in the endourological treatment of kidney stones. In our study, we aimed to compare the effectiveness of these methods in kidney stones larger than 2 cm. MATER?AL METHODS: We searched 822 outpatients who applied to the Department of Urology, University of Health Sciences Sisli Etfal Training and Research Hospital outpatient clinic between June 2020 and March 2022 and were diagnosed with urinary tract stones, using the hospital database. We included 282 patients who were diagnosed with kidney stones larger than 2 cm after exclusion criteria and had not undergone surgery before. They were randomized into two treatment groups, Flexible Ureteroscopy (F-URS) and Percutaneous Nephrolithotripsy (PCNL). Demographic data of the patients were extracted. Before treatment from each patient; Complete urinalysis, hemogram, biochemistry, direct urinary system radiography (DUSG), intravenous pyelography (IVP) and non-contrast abdominal computed tomography (CT) were extracted from archive records. Control CT of the entire abdomen was requested in the 3rd week following the operation for 282 patients included in the study.RESULTS and DISCUSSION: While the values of the F-URS group were statistically significantly higher in terms of BMI, body surface area, DM, hyperlipidemia, and stone bilaterality rate, the PCNL group was statistically significantly lower in terms of the number of stones and stone volume. (respectively p=0.012 p=0.012 p=0.013 p=0.011 p=0.043 p<0.001 p<0.001). Operation success factors; When the stone-free rate is examined, it is seen that the stone-free rate of the F-URS group is statistically significantly lower than the PCNL group. (p=0.005). Scope time, operation time and hospitalization time of the F-URS group were found to be statistically significantly shorter than PCNL group data (p=0.002 p<0.001 p<0.001). A statistically significant difference was found in the complication rates of the groups (p<0.017). The complication-free rate of the F-URS group was significantly higher than the PCNL group data. As a result of statistical analyzes, we found a lower stone-free rate in the F-URS group. On the other hand, we found a higher risk of complications in the PCNL group.CONCLUSION: Both surgical options we compared are applicable methods with high success rates. Although PCNL is the gold standard in the treatment of kidney stones larger than 2 cm, it should be noted that similar success rates can be achieved with the F-URS procedure applied multiple times. Today, especially in the treatment of patients with bleeding diathesis, skeletal anomaly or morbid obesity, and rest stones after ESWL; F-URS is the first option.