Complete staghorn calculi are typically managed with percutaneous nephrolithotomy (PCNL). However, dilating nephrostomy and inserting a nephro access sheath can be difficult to perform without hydronephrosis. We reported the procedure of ureteroscopy-assisted retrograde nephrostomy (UARN) during PCNL. UARN is effective without dilating the renal collecting system in cases of complete staghorn calculi. A 63-year old female with a left complete staghorn renal calculus was referred to our hospital. Under general and epidural anesthesia, the patient was placed in a modified-Valdivia position. A flexible ureteroscope was inserted and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible ureteroscope. The puncture wire was forwarded along the route from the renal pelvis to the exit skin. Calculus fragmentation was done using a pneumatic lithotripter and the Ho: YAG laser. UARN during PCNL was effective for the treatment of a complete staghorn calculus.
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