Abstract: Objective To compare the clinical efficacy, duration of hospitalization and hospitalization cost of flexible ureteroscopic lithotripsy(FURL) or percutaneous nephrolithotripsy(PCNL) after extracorporeal shock wave lithotripsy(ESWL) for the treatment of upper calyx calculi with a diameter of 1~2 cm.Methods A retrospective analysis was performed on 101 patients with renal upper calyx calculi who failed to respond to ESWL treatment in Affiliated Hospital of Xuzhou Medical University from January 2017 to November 2021. The calculi diameter was 1~2 cm. Patients were divided into FURL group(n=48) and PCNL group(n=53) according to different surgical methods. Intraoperative blood loss, operation time, postoperative hospital stay, hospitalization cost, preoperative and postoperative inflammatory indicators 1 day, postoperative visual analogue score(VAS) of 6 h and 24 h, postoperative complications, and stone clearance rate 1 month and 3 months after surgery were compared between the two groups.Results Compared with PCNL group, FURL group had less intraoperative blood loss, shorter postoperative hospital stay, lower incidence of postoperative complications, and lower VAS at 6 and 24 hours after surgery(P<0.05). Compared with FURL group, PCNL group had shorter operation time and lower hospitalization cost(P<0.05). Peripheral blood white blood cell count(WBC), neutrophil to lymphocyte ratio(NLR) and C-reactive protein(CRP) levels were all increased 1 day after surgery in both groups(P<0.01), but the levels of WBC, NLR and CRP in FURL group were significantly lower than those in PCNL group(P<0.01). There was no significant difference in stone clearance rates 1 and 3 months after surgery between the two groups(P>0.05).Conclusions After ESWL treatment failed in patients with 1~2 cm diameter upper calyx calculi, both FURL and PCNL can effectively remove stones. The difference lies in that FURL has little blood loss, short hospitalization period, mild pain and few postoperative complications, and reduces postoperative inflammation, while PCNL has short operation time and low overall hospitalization cost. Patients can reasonably choose surgical programs according to their own conditions in clinical practice.