Background: Nephrolithiasis is a common disease with a 10% lifetime risk in men and 5% in women. With the emergence of noninvasive and minimally invasive methods, the management of renal stones has vastly improved.

Objective: Comparison of effectiveness of percutaneous nephrolithotomy vs retrograde intrarenal surgery for the treatment of renal pelvis stones.

Methodology: This study was randomized controlled trial carried out at the Department of Urology and Renal Transplantation, Institute of Kidney Diseases Hayatabad Medical Complex,Peshawar for six months from 23-09-2018 to 22-03-2019. Total sample size was 70 patients. Patients in group A underwent Percutaneous Nephrolithotomy (PCNL) and Group B will be subjected to RIRS. All the patients will be advised for follow up visit at 2 weeks post operatively to determine intervention effectiveness in terms of complete stone clearance.

Results: The mean size of the stone was 17.47mm ± 1.7SD, ranges 15 to 20 mm in both groups. In group A, PCNL Procedure was effective in 34(97.1%) patients at completion of study. While in group B, 28(80%) patients were effectively stone cleared. which is significant with p-value=0.027.

Conclusion: Percutaneous Nephrolithotomy (PCNL) is more efficient and safe procedure for renal stone of size 1.5cm to 2 cm as compared to RIRS. Studies show that PCNL is more effective than retrograde intrarenal surgery in the treatment of renal pelvis stones. In the light of recent data, PCNL seems to be an ideal treatment modality in the management of patients. Nevertheless, these results must be confirmed by further prospective large randomized trials.