Urolithiasis is a common disease of the urinary system, and percutaneous nephrolithotomy (PCNL) is one of the main and effective methods for the treatment of complex renal calculi. Accurate puncture and safe tract dilation are the key steps that determine the success of the operation, especially for patients with stones without hydronephrosis, in whom the renal cortex is relatively thick, the blood vessels are abundant, and the operation space of the target renal calyx is limited. These make the intraoperative puncture difficult and tend to lead to bleeding and tract loss during the puncture and dilation process, which increases the difficulty of the operation. This article reviews the current status of the establishment of percutaneous renal tract for PCNL in patients with renal stones without hydronephrosis.