OBJECTIVE: To assess how much can fluoroscopy assisted US guided puncture reduce radiation exposure in PCNL, and can it achieve equivalent results compared to the traditinoal fluorosocpy technique in PCNL. METHODS: From July 2022 to August 2023, 50 patients receiving mini-percutaneous nephrolithotomy (mini-PCNL) were included in a prospective randomized study. Two groups of twenty-five patients each were formed. Those in Group A received fluoroscopy-only guided (FG) puncture, whereas those in Group B received fluoroscopy assisted ultrasound guided (FUSG) puncture. Analysis was done on the following variables: stone-free rate, complication rate, fluoroscopy time, and demographic data. RESULTS: Mean age in group A compared to group B was 7.24 ± 3.72 vs. 8.0 ± ±3.77 years respectively. The addition of ultrasonic guiding resulted in a considerable reduction in fluoroscopy duration, from 157.9 ± 68.54 seconds in group A to 29.44 ± 17.01 seconds in group B (p <
0.05). The radiation dosage was significantly lower in group B (6.07 ± 3.57) mGy compared to group A (32.35 ± 13.79) mGy (p <
0.05). In group A, the time to puncture was 136.6 ± 50.78 (sec), but in group B, it was 52.20 ± 33.20 (sec) (p <
0.05). The universal stone-free rate was 95.3%, with no discernible statistical trend. Group A's complications rate was 16%, while group B reported complication rate of 12%, with no statistically significant difference (p 0.653). CONCLUSION: fluoroscopy-assisted ultrasound guidance in Mini-PCNL is a safer and more effective approach than fluoroscopy alone in our experince.