In the present study, the authors analyze the radical change in the treatment of complex renal lithiasis. They advocate the use of this combined approach in patients with a large stone mass or those with obstructive problems of the urinary tract. They discuss the contraindications of this technique; i.e., pelvic kidney, septic urinary infections and severe cardiopulmonary disease. From 1983 to June 1988, a total of 5,657 stone patients were treated at their department; 921 were treated by PCNL combined with ESWL. In 92% of the cases, PCNL was successful in removing most of the stone mass. The complications encountered were fever, hemorrhage, colon perforation, stenosis of UPJ post-PCNL and intrathoracic extravasation. Nephrectomy was warranted in 2 cases due to complication.