AbdelRazek M, Abolyosr A, AbdelKader MS, et al. - This prospective randomized clinical study was undertaken to determine the impact and result of percutaneous nephrolithotomy (PNL) vs extracorporeal shock wave lithotripsy (SWL) in patients experiencing renal insufficiency. This analysis involved 104 renal insufficiency patients having renal stones (serum creatinine 2–4 mg/dl and eGFR < 60 ml/min/1.73 m ² more than 3 months) who were randomized into two groups: Group A had PNL; Group B received SWL. The stone-free rate was identified to be 84% in Group A vs 26.6% in Group B following the first SWL session. Significant improvement of serum creatinine levels by 9.1%, significant improvement of creatinine clearance and eGFR, all were observed on comparing pre and postoperative outcomes of Group A. Although concerning Group B preoperatively and 3 months post-SWL, a significant improvement by 8.7% was evident which was less than that of Group A, eGFR also improved by 6.7% which was less than the eGFR improvement in Group A (12.3%). Findings showed that encouraging results were conferred by PNL and SWL as minimally invasive procedures for renal insufficiency and renal stones cases, with no negative impacts on renal function.