Two main endourological modalities standout today for kidney stones treatment, the retrograde intrarenal surgery (RIRS) and the percutaneous nephrolithotomy (PCNL), by and large, the former for small stones (< 2 cm) and the latter for larger stones (> 2 cm), but technological refinements have broadened both approaches’ indications. Moreover, the miniaturized PCNL (mPCNL) has proved to decrease bleeding, one of PCNL possible complications, while keeping excellent stone-free rates (SFR). Thus, there is an overlapping in the indications for medium-sized stones treatment, generating a constant debate on whether one outperforms the other in terms of effectiveness and safety.