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Introduction: Renal artery pseudoaneurysm is a rare yet serious complication following percutaneous nephrolithotomy, especially in patients with solitary kidneys. Effective management is crucial to prevent further renal damage., Case Presentation: We report a case of a 41-year-old male with a solitary kidney who experienced gross hematuria and renal insufficiency 3 months after percutaneous nephrolithotomy. Due to the patient's renal insufficiency and the risks associated with arterial catheterization, ultrasound-guided embolization was chosen as the treatment approach. Initial angiographic attempts were impeded by renal vessel spasms, delaying intervention. However, successful direct percutaneous embolization was subsequently performed using ultrasound and digital subtraction angiography., Conclusion: The patient's recovery was uneventful, and follow-up assessments showed no recurrence of renal artery pseudoaneurysm. This case highlights the effectiveness of ultrasound-guided embolization as a viable treatment option for post-percutaneous nephrolithotomy renal artery pseudoaneurysm, particularly in patients with solitary kidneys., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.)