There are many methods to combine the use of a flexible ureteroscopy and a nephroscope. This case shows a good sample of performing ECIRS for a complete staghorn stone in the left kidney. Lt kidney upper pole stone was difficult to be removed using the pre-existing percutaneous nephrostomy tract in the lower pole during the 18Fr mini-PCNL procedure.

- Discussion: Another percutaneous puncture? Use of flexible cystoscope or ureteroscope through the pre-existing percutaneous tract? Combination of RIRS??