Retrograde percutaneous nephrostomy puncture to aid in stone removal is a safe and acceptable alternative to antegrade techniques. For urologists with expertise in endoscopic instrumentation and technique, it is easy to learn and does not require the presence of a skilled interventional radiologist. The advantages of the technique are that it can be performed in a non-dilated collecting system and can result in more accurate and less traumatic puncture. We have found it difficult to use in the presence of staghorn calculi filling the kidney, and its application is obviously limited if access to the lower urinary tract and ureter cannot be obtained. If the technique is unsuccessful, it does not preclude or complicate immediate antegrade percutaneous or open stone removal.