From December 2001 to August 2010, 831 B-ultrasound-guided percutaneous nephrolithoscopic procedures were performed, 571 in men and 360 in women. The patient’s age ranged from 12 to 69 years, with an average of 45 years. Results: Among the 831 cases, 582 cases were single-channel stone extraction, 249 cases were multi-channel stone extraction, and the maximum number of channels was 4. 8 cases were surgically explored due to bleeding and failed puncture. Conclusion: In percutaneous nephrolithotomy, trans-B ultrasound-guided nephrolithotomy is convenient and practical, and the complications can be reduced with repeated practice and experience. Percutaneous nephrolithotomy is a very experienced surgery, requiring the operator to be experienced in order to complete the surgery perfectly, and various situations may occur at each step, all of which need to be handled correctly, and at the same time, the surgery also requires the operator to have great patience. First of all, the anesthesia method, in general, should be performed with general tracheal intubation, because this can cope with a variety of situations, especially with large stones, long operation time and many uncertainties. Epidural anesthesia can be considered only in some cases, such as when the kidney stone is small, the effusion is obvious, the kidney puncture is easy, or when the ureteral stone is small, the stone is located downward and can be easily removed, when the operation is estimated to be short and the patient is in good condition, etc. Intravenous complex anesthesia is sometimes possible if only for renal puncture access establishment, for drainage or when the procedure is simple. Patient position: the general classical position is prone, generally so that the patient has to be under general anesthesia, in order to ensure airway patency and patient management. The lateral or reclined position can also be used, and special positions can also be used due to the patient’s special condition. Procedure: Generally, the ureteral tube on the affected side should be built-in first, with the following purposes: 1. The ureteral tube can be placed while observing the ureter on the affected side to exclude ureteral stones or to deal with ureteral stones at the same time; the ureteral catheter can be placed to cause artificial hydronephrosis through this tube, which helps to establish the renal puncture channel; 2. The tube can be used to prevent intraoperative kidney stones from rushing into the ureter and blocking the ureter; the tube can be used to inject water or gas, which facilitates the intraoperative search for the ureteral opening in the percutaneous nephrectomy field; or a guide wire can be inserted through this tube, which facilitates the intraoperative placement of the D-J tube. The ureteral catheter can be placed through a cystoscope, but for observation and management of intraureteral stones, ureteroscopic placement of the ureteral catheter is usually used. The application of ureteroscopic placement should be noted that when the patient has inflammation of the bladder, bleeding or abnormal ureteral deformity, it will now be difficult to place. Reasons: 1. Ureteral orifice malformation, congenital ureteral orifice stenosis, ectopic or abnormal angle, congenital duplicate ureter, so preoperative IVU or CTU examination is necessary. 2. Ureteral stone obstruction. 3. In men with prostatic hyperplasia, the ureter is difficult to find or located in the visual dead space due to prostate. 4. Cystitis or prolonged ureter with bladder mucosa edema, resulting in unclear ureteral orifice. Treatment: 1. Preoperatively, patients with cystitis or bladder bleeding should control inflammation and eliminate bladder edema. 2. Preoperative imaging to rule out ureteral malformations and understand the location of the ureter. 3. Before intubation, there should be adequate estimation, and the entry of the mirror should be gentle to reduce the damage to the bladder mucosa and reduce bleeding. When searching for the ureteral opening and inserting the guidewire, be patient and remember to venture in blindly, causing damage to the orifice and bleeding so that the orifice is more difficult to identify.4 , The orifice on the normal side can be found first, and the orifice on the diseased side can be found along the ureteral ridge. You can also fill or empty the bladder, the shape of the ureteral orifice is prominent, often with a collection of blood vessels; when the orifice is not clear, do not rush to insert the catheter, you can adjust the angle of the mirror and gently insert the guidewire, if the guidewire is not suitable or to replace the guidewire. Avoid rough insertion of the guidewire or ureteroscope body causing damage to the bladder mucosa or the formation of a false channel. At this time, the tube should be flushed while the outer upper side of the tube mouth, gently manipulated to find the tube mouth. Follow the fiber walk to find it.5. You can also consider replacing the cystoscope cannula or using an electrosurgery to remove the surface of the bulge of the canal before looking for the canal (this method is not usually used).