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To evaluate the therapeutic effect of minimally invasive percutaneous nephrolithotomy (MPCNL) under ultrasonic and X-ray guidance in the treatment of complicated renal calculi.A retrospective analysis was conducted among 36 patients undergoing MPCNL under ultrasonic and X-ray guidance for complicated renal calculi. The general clinical data, stone size, operative time, blood loss, complications and stone clearance rate were analyzed.Double working channel was established accurately under ultrasonic and X-ray guidance in the 36 cases. The stone clearance rate in one treatment session was 80.56%, with an average operation time of 100 min and a mean hospital stay of 13.5 days (13-15 days) after operation. A second lithotripsy was performed in 5 cases and no residual renal calculi were found 1 month after the operation. Sixteen out of the 18 patients with preoperative elevation of serum creatinine recovered normal creatinine level after the operation.MPCNL under ultrasonic and X-ray guidance is safe and effective for treatment of complicated renal calculi and is associated with few postoperative complications.