Percutaneous removal of renal or ureteral calculi requires fluoroscopic guidance of nephrostomy tube insertion, tract dilation and stone manipulation. We introduce an effective method of nephrostomy tract dilation with optic urethrotomy under direct visual control, which protects the patient and medical personnel from fluoroscopic exposure without further increasing the incidence of immediate and delayed vascular complications. In our series of 70 patients (73 kidneys) only 1 (1.4 per cent) had hypovolemic shock, with no kidney loss or operative mortality encountered. Of the kidneys 69 were operated on in 1 and 4 in 2 sessions. There was only 1 failure, for a success rate of 98.6 per cent and the stones were reached in all cases.

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