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had a mean stone size 51 mm +/-22 s.d. (range 13-72 mm). Stones were single in 55%, multiple/staghorn in 45% of cases, with 24% coexistent ureteral stones. Mean operative time was 88 minutes +/-35 s.d., including patient positioning. Preliminary semirigid ureteroscopy was performed in 81% of cases, additional flexible ureteroscopy in 53%. Endovision aid to fluoroscopy/ultrasound renal access (90% inferior calyx, 94% single access) was possible in 39% of cases. Retrograde ureteroscopy (ureteral stone treatment, in situ lithotripsy, stone fragments retrieval in calyces parallel to the access tract,.) had an active role in 54% of cases. The stone-free rate was 89.8%, 94.3% after an early second percutaneous look during the same hospital stay. The overall complication rate was 7.4% (1.6% of cases Clavien 3 and never more, no ureteral lesions). Mean fluoroscopy time of the 'reallyendoscopic' cases was 3.3 minutes +/-1.2 s.d., versus 5.5 +/-3 s.d. of the other ECIRS. CONCLUSIONS: ECIRS represents a comprehensive approach to PNL, personalizing stone management and tailoring all intraoperative choices on the patient. Retrograde flexible ureteroscopy, after preliminary evaluation of the dynamic anatomy of collecting system and stones, actively contributes to safety and efficacy of ECIRS, optimizing stone-free rates and reducing complications and radiation exposure.