During a four year period, ending May 1987, 154 cases of symptomatic staghorn calculi have been treated by percutaneous nephrolithotomy. Of these patients, 86% were discharged completely stone free with the remainder having fragments less than 5mm in greatest diameter. More than one operative procedure during the same hospitalization was required in 24% of patients and multiple percutaneous tracts were established in excess of 73% of them. Significant complications occured in 16% of patients and there was one death. Most complications can begenerally be minimized by careful approach and manageable by interventional radiological means. The management of patients with staghorn calculi requires a comprehensive understanding of the renal anatomy, selection of appropriate percutaneous nephrostomy tract sites, and radiologic-urologic expertise needed to remove the largestone mass. The advent of extracorporeal shock wave lithotripsy will not abolish the need for nephrolithotomy, particulariy complex stones such as staghorn calculi.