Background: Flexible ureteroscope (FURS) and Extracorporeal Shock WaveLithotripsy (ESWL) are treatment options in patients with Renal calculi up to 2 cm Objective:to evaluate whether the two procedures are superior for treatingrenal stones with a low radiation exposure risk. Patients and Methods:the study included 50 patientscomplaining of Renal stones less than 2 cm. Patients underwent either FURS or ESWL randomly. The procedures were done at Kafr Elsheikh University Hospital. The patients were divided into two groups. Group A: Patients received a Flexible ureteroscope (FURS). Group B: patients underwentExtracorporeal Shock Wave Lithotripsy (ESWL). Results:No statistically significant difference was found between the two studied groups regarding age, sex, size, and BMI. Also, there was a statistically significant difference regarding hospital stay,stone-free rate, radiation time, and the air kerma-area product. Patients who underwent ESWL were exposed to an ionizing radiation dose with a mean of 2386.49 cGy*cm2 (SD=760.96 cGy*cm2). In the URS group, a mean of 4976.5 cGy*cm2 (SD=1559.83 cGy*cm2) with (P value <0.001). Conclusion: FURS is considered highly efficient, with a higher stone-free rate after a single procedure than ESWL.The patients treated by FURS had higher exposure to ionizing radiation doses than patients treated by ESWL.