PURPOSE: We present a series of 55 patients with complete staghorn stones and assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) with a combination pneumatic and ultrasonic Lithotrite. MATERIALS AND METHODS: Between January 2003 and June 2007, a total of 55 patients with 58 complete staghorn stones underwent PCNL with a combination pneumatic and ultrasonic Lithotrite. Patients with significant residual fragments also underwent extracorporeal shock wave lithotripsy (ESWL). Intraoperative and postoperative parameters were evaluated and stone free rate was assessed at 3-month followup. RESULTS: The mean number of PCNL for each renal unit was 1.6 (range 1 to 3) and that of ESWL was 1.4 (range 0 to 4). The mean number of tracts created for each PCNL was 1.2 (range 1 to 2). The mean operative time was 65.6 minutes (range 30 to 200). The stone free rate was 67%. The mean length of hospitalization was 6.8 days (range 3 to 14 days). Postoperative transfusion rate was 36% and the mean amount was 3.2 units of pack red blood cell (range 0 to 8). Immediate major complication occurred in 5 patients (5.3%), including 1 septic shock, 4 massive bleeding needing transfer to intensive care unit in 2, and transarterial embolization in 2. Mortality rate is 0%. The most common stone composition was mixed component of calcium oxalate and calcium phosphate (60.5%). The most common bacteria found in urine culture was E. coli (39.1%). CONCLUSIONS: Treatment of complete staghorn stones with the combination of pneumatic and ultrasonic lithotrite is efficient and safe. The operative time was shortened with comparable stone free rate.