In the horseshoe kidney, the two lower poles of the kidney are mostly fused into an isthmus anterior to the spine, the ureter is connected to the renal pelvis at a high level, accompanied by poor renal rotation, and the groups of renal calyces face dorsally. Therefore, the kidney position is lower than normal and the upper pole of the kidney is more posteriorly lateral, which causes some difficulties in positioning the puncture access for percutaneous nephrolithotomy. Perfecting CTU examination before surgery to understand the anatomical relationship between the stone and the collecting system also allows for minimally invasive PCNL treatment of horseshoe kidney stones. Since the upper ureter crosses the walking and connects with the renal pelvis in the anterolateral position of the isthmus, slopes at the UPJ, and the narrow funnel part of the renal calyx, which causes the residual stones to be difficult to discharge by themselves after surgery, especially the stones in the lower renal calyx, all stones should be removed as much as possible during surgery, and multi-channel lithotripsy should be performed to retrieve stones if necessary.