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Advances in techniques and skills within the specialties of urology and invasive radiology have dramatically changed the treatment of renal calculus disease. One recently developed treatment is percutaneous ultrasonic lithotripsy, which consists of passing a rigid tube (nephroscope) through a small skin incision into the kidney. A hollow steel tube passed through the nephroscope carries ultrasonic energy, which gradually fragments the stone when the tube is brought into contact with it. In this article, Drs Crowley and Smith explain the technique and its complications. They also review patient selection, the postoperative course of a typical patient, and the overall success of the procedure.