Background: The role of ureteroscopy has dramatically evolved over the past twenty years driven by profound enhancement in various factors and assisting techniques such as the ureteroscope size, deflection capabilities, video-imaging, and in lithotripsy (stone breakage) with the advent of holmium laser, however, the stone size plays a critical role in determining outcomes and operative approach. Aim of the work: we conducted a systematic review of the literature to look at the safety and efficacy of flexible utereroscopy and laser lithotripsy intervention in patients with stone disease; particularly those with stones larger than 2 cm. Methods: A systematic search was performed in the scientific database particularlyMEDLINE (2000–2017), EMBASE (2000– 2017), Cochrane Central Register of Controlled Trials, CINAHL (2000–2017), Google Scholar, and individual urologic journals.
 Results: The search yielded eight studies involving 392 patients, (390 renal units) were reportedly treated with FURSL. The mean operative time was 80.7 minutes (26-215 min). The mean stone-free rate was 91.2% (77%-96.7%), with an average of 1.6 procedures per patient. The mean stone size was 2.5 cm except for one most recent study which reported stones size less than 0.5 cm. An overall complication rate was 8.1%. Major complications developed in 21 (4.2%) patients and minor complications developed in 19 (3.9%) patients.
Conclusion: Flexible Ureteroscopy and Laser Lithotripsy intervention has proven to be not only a less invasive treatment but also a successful with a low complication and stone free rate (SFR) for renal calci larger than 2 cm. FURSL may represent an alternative therapy to standard percutaneous nephrolithotomy (PCNL) with satisfactory efficacy and low morbidity.