Isolated kidney cast stones are often combined with renal insufficiency or compensatory enlargement of the kidney, which is a more difficult problem for urologists. Traditional open surgery is risky, difficult to extract stones, easy to bleed, and the residual stones after surgery can easily cause urinary tract obstruction and lead to renal failure. Minimally invasive percutaneous nephrolithotomy has become the treatment of choice for complex kidney stones because of its low trauma, low bleeding and fast recovery. However, due to the rich vascularity of isolated kidney parenchyma, the chances of complications of hemorrhage or infection increase during and after surgery, so it is especially important to make adequate perioperative preparation. With the accumulation of experience and the increase of surgical cases, minimally invasive PCNL is still a safe and feasible treatment for isolated kidney cast stones, with exact results, less trauma and faster recovery.