”Pilot kidney stones”, as the name implies, are kidney stones in a specific group of patients who are or will be involved in aviation and related occupations. Most of the stones found during the medical examination tend to be small in size. To ensure safety, pilots must emphasize “stone free flight”. Rapid and complete stone removal with minimal trauma is a requirement for the treatment of these patients. Therefore, the choice of treatment plan is very important. One study reported that the lost time for extracorporeal shock wave lithotripsy and PCNL in pilot patients was 4.7 weeks and 2.6 weeks, respectively, compared to 1.7 weeks for flexible ureteroscopy. Also, due to the nature of the pilot’s profession, he/she has centrifugal movements during flight and training, resulting in the distribution of stones in the lower calyces. Therefore, flexible ureteroscopy has unique advantages in the treatment of “pilot kidney stones”. Not only can the distribution of stones in the renal collecting system be observed comprehensively, but also the stones can be crushed by Holmium laser and removed completely by combining with the mesh basket, avoiding the obstacle of stone removal due to the abnormal structure of the renal calyces. In this regard, Beida People’s Hospital has achieved good results in treating “pilot kidney stones” with flexible ureteroscopy and recommends this method as the first-line treatment option.