OBJECTIVE: To investigate the feasibility and superiority of ultrasound-guided mini -percutaneous nephrolithotomy (mini-PNL) for the treatment of upper urinary tract stones. METHODS: A total of 896 cases of ultrasound-guided mini -percutaneous nephrolithotomy were performed, including 396 cases of renal deerstalker stones, 350 cases of renal pelvic stones, 143 cases of upper ureteral stones and 7 cases of transplanted kidney stones. Results: Among 896 patients, 146 cases (16.3%) were assessed by preoperative ultrasound to have mild hydronephrosis, and the ureter was intubated before puncture and saline was injected to form artificial hydronephrosis to facilitate puncture. 872 cases (97.3%) were successfully punctured once, and the remaining 24 cases (2.7%) were successfully punctured by the second time after one week, 22 cases were successful, and 2 cases were successfully punctured by X-ray localization instead; ultrasound found during lithotripsy Ultrasound detected >5 mm stones in 345 cases (38.5%), which were localized and crushed under ultrasound guidance. After postoperative ultrasound follow-up every two weeks, 823 of 896 patients (91.8%) had complete stone clearance, and 73 (8.2%) had small residual stones after 1 month. Complications included fever in 111 cases (12.3%), including 8 cases of hyperthermia with bacteremia sepsis; bleeding in 138 cases (15.4%), including 2 cases of inferior vena cava injury but no serious bleeding; pleural effusion in 3 cases (0.3%); and no intra-abdominal organ injury. Conclusion: Ultrasound can make accurate judgments and guide preoperative preparation for proposed microchannel PNL; intraoperative ultrasound guidance can improve the success rate of puncture and effectively avoid vascular and organ injuries and large stone residues; postoperative surgical efficacy can be correctly evaluated. Ultrasound-guided microchannel PNL is safe and feasible for the treatment of upper urinary tract stones, and is suitable for promotion and application in primary hospitals.