The patient, male, 49 years old, had a history of bilateral kidney stones for more than 20 years, and the right kidney stones were removed by right nephrectomy 17 years ago. In June this year, the patient was admitted to our hospital with “left lumbar pain for half a month”, and was diagnosed as: multiple stones in both kidneys, chronic renal insufficiency, bilateral hydronephrosis, urinary tract infection, right kidney atrophy (non-functional), and sequelae of cerebral hemorrhage. He was admitted with a creatinine of 390 umol/L, underwent ultrasound-guided left nephrostomy for drainage, drained purulent urine, and was discharged with bacterial culture of ESBLs-producing Escherichia coli, and was given anti-infective and continuous drainage treatment. The patient was readmitted 3 months later and the creatinine was 320umol/L. The department discussed that the patient had severe atrophy and non-function of the right kidney, and the left kidney was severely impaired with chronic renal insufficiency. After continuous nephrostomy and drainage, the left kidney still had significant fluid accumulation, which was considered to be related to the pelvis and calyces full of stones, and the disconnection or poor drainage of the calyces. The stones were multiple stones, the largest of which was antler-shaped with a length of about 250 px and covered the renal pelvis and several renal calyces. The kidney was severely infected, with purulent urine draining from the previously punctured renal calyces, and the possibility of purulent urine from the remaining calyces was great. The treatment plan was determined to be multi-stage multichannel percutaneous nephrolithotomy. After full communication with the patient, percutaneous nephrolithotomy was performed. During the operation, the posterior group of the middle left renal calyces was punctured, and purulent urine was penetrated, and the stone was found to be unusually hard in texture and difficult to be crushed by ultrasonic probe. The combination of pneumatic ballast, ultrasonic probe and stone extraction forceps was applied to remove the target calyx stone and part of the renal pelvis stone in order to adequately drain the urine from the renal pelvis and calyx and help control urinary tract infection. Thereafter, percutaneous nephrolithotomy was performed in three stages with three percutaneous renal channels, and most of the stones were removed, with a few remaining stones in the lower calyces. The patient’s right kidney was atrophied and non-functional, and the left kidney was severely impaired, with chronic renal insufficiency, combined with high-load multiple hard kidney stones and severe infection, making the operation difficult and risky.