Objective To explore the clinical efficacy of ultrasound-guided percutaneous nephrolithotomy EMS pneumatic ballistic combined with ultrasonic lithotripsy for stone extraction. Methods Clinical data of 268 patients treated with ultrasound-guided percutaneous nephrolithotomy EMS pneumatic ballistic combined with ultrasonic lithotripsy for upper urinary tract stones were retrospectively analyzed and summarized. Results 266 cases were established percutaneous renal access in one stage, and 2 cases were converted to open surgery due to bleeding intraoperatively. The operation time ranged from 45 to 125 min, with an average of 80 min. 255 cases of single-channel, 11 cases of double-channel, 260 cases of lithotripsy were completed in the first stage, and 6 cases of lithotripsy were completed in the second stage. There were no serious intraoperative complications. 1 case of postoperative hemorrhage was treated with interventional embolization to stop bleeding; 1 case died due to uremic sepsis. Conclusion: Ultrasound-guided percutaneous nephrolithotomy with pneumatic ballistic combined with ultrasonic lithotripsy has the characteristics of high efficiency and minimally invasive, which can replace open surgery; bleeding and infection are serious complications, which should be paid attention to.