Objective To compare the clinical efficacy of ultrasound and C - arm X - ray in establishing percutaneous nephrolithotomy aisles. Methods Sixty cases percutaneous nephrolithotomy operations, excepting upper urinary tract anatomy abnormality, were analyzed from January 2008 to October 2008. Of the 30 cases were located by ultrasound (ultrasound group) , 16 males and 14 females, the average age was 45 ～ 12. And 30 cases were located by C - ann X - ray (X - ray group) , 18 males and 12 females, the average age was 44 ± 13. Results The whole puncture success rate of the two groups was 96.7% and 93.3% (P = 0. 554). The time of establishing pathway was (13 ±3)min and (22±4)min(P <0.01); puncture success rate in one time was 86.7% and 60. 0% (P =0. 02). Conclusions Located by ultrasound to establish pereutaneous nephrolithotomy aisles is more predominant than C - arm X - ray, and has no radiation injury.