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The most popular management for upper ureteral stones is shock wave lithotripsy (SWL) because of its noninvasiveness, low morbidity, and high success rates (85–93 %). With the development of smaller caliber semirigid ureteroscopes (URSs) and the improvement of instrumentation, URS became safer and highly effective as a treatment modality for proximal ureteral stones.

Currently, percutaneous nephrolithotomy (PCNL) is the treatment of choice for large, complex renal stones and staghorn stones, and percutaneous renal surgery (PRS) has become a daily urological practice. The complications of PRS are specific for the procedure, and they include bleeding, injury to adjacent organs, and sepsis. Bleeding complications during or after PRS are the most dangerous and life-threatening of them. The reported incidence of blood transfusion after PCNL ranged between 0 and 23 %. The need of selective renal artery angiography and embolization ranged between 0.3 and 1.4 %. Bleeding complications of PRS cannot be completely avoided, and direct control of bleeding through the nephrostomy tracts is generally difficult. In this chapter, we will present management of bleeding complications of PRS with special focus on identifications of risk factors and technical steps to avoid this frustrating complication.

Treatment of calculi in patients with congenital renal anomalies (such as horseshoe, ectopic, autosomal dominant polycystic kidneys, and duplex systems) requires special considerations. These kidneys had abnormal vascular, altered calyceal orientation, and variable anatomical relations with the surrounding viscera. Nowadays, minimally invasive techniques (such as extracorporeal shock wave lithotripsy [SWL], flexible ureterorenoscopy [F-URS], percutaneous nephrolithotomy [PNL] and laparoscopic pyelolithotomy) are the most frequently used modalities for treatment of calculi in both normal and anomalous kidneys. They offer high stone-free rates with minimal morbidity and improved recovery. However, there are many challenges in utilization of these modalities in patients with renal anomalies.