Background We evaluated the hydrostatic pressure of the renal pelvis (RPP) as a radiation-free alternative to fluoroscopic nephrostogram to assess ureteral patency after percutaneous nephrolithotomy (PCNL). Methods Retrospective non-inferiority study analyzing 248 PCNL-patients (86 female (35%) and 162 males (65%)) between 2007 and 2015. Postoperatively, RPP was measured using a central venous pressure manometer in cmH2O. The primary endpoint was to assess RPP depending on the patency of the ureter and the nephrostomy tube removal. Secondary, the upper limit of normal RPP of $$\le$$ ≤ 20 cmH2O was assessed as an indicator of an unobstructed patency. Results The median procedure duration was 141 min (112–171.5) with a stone free rate of 82% (n = 202). RPP was significantly higher in patients with obstructive nephrostogram with 25.0 mmH2O (21.0–32.0) versus 20.0 mmH2O (16.0–24.0; p < 0.001). The pressure was lower in successful nephrostomy removal with 18 cmH2O (15–21) versus 23 cmH2O (20–29) in the leakage group (p < 0.001). The analysis of a cut-off of $$\le$$ ≤ 20 cmH2O showed a sensitivity of 76.9% (95% CI [60.7%; 88.9%]) and a specificity of 61.5% (95% CI [54.6%; 68.2%]). The negative predictive value was 93.4% (95% CI: [87.9%; 97.0%]) and the positive predictive value 27.3% (95% CI [19.2%; 36.6%]). The accuracy of the model showed an AUC = 0.795 (95% CI [0.668; 0.862]). Conclusion The hydrostatic RPP seems to allow a bedside evaluation of ureteral patency after PCNL.