Objectives  To report the treatment procedure of alternating use of retrograde rigid and flexible ureteroscopy combined with Holmium laser lithotripsy in the treatment of complete staghorn calculus of a unilateral kidney in elderly patients over the age of 60 years and to evaluate its efficiency. Methods  11 patients of such kind underwent this treatment procedure from January, 2012 to May 2013. They were 60~77 years old( mean 67±7.2 yrs). Severe hematuria was their main complaints. 7Fr Bard double J stent was placed in ureter one week before operation routinely. Firstly, retrograde rigid ureteroscopic Holmium laser broke up the part of pyelocalyceal calculi in direct vision. Then flexible ureteroscopy was used to treat the remainder of staghorn calculi. The procedure of lithotripsy might be divided into stages but the operative time of one stage was controlled within 120 minutes. Second-look lithotripsy was performed in patients with significant residual fragments. Stone clearance was defined as no fragments or a single fragment less than or equal to 4 mm in diameter on standard radiograph at 3-month follow-up. Results  All 11 patients underwent the operations safely and no complications happened. In all, one case (9.1%) were stone-free after the first procedure and another 10 needed an second-look procedure to become stone-free, resulting in a 90.9% stone-free rate. Conclusions  In these select patients, complete staghorn renal calculi can be treated safely and efficiently with retrograde rigid and flexible ureteroscopic techniques. Especially, blood circulation systems of these patients were not interfered with this kind of procedure perioperatively. Staged, retrograde, alternating rigid and flexible ureteroscopy combined with Holmium laser may be one of first-class therapy with acceptable efficacy and low morbidity for complete staghorn calculus of a unilateral
kidney in elderly patients over the age of 60 years.