Urologists have witnessed replacement of complex open surgical procedures with minimally invasive therapies over the past quarter century. Nothing personifies this more than an anatrophic nephrolithotomy in the management of kidney stones. The Boyce procedure, once the gold standard for staghorn calculi, is rarely performed. Percutaneous nephrolithotomy (PCNL) has become the gold standard procedure for large renal stones and staghorns. This article will review the hemorrhagic complications that are associated with PCNL and the necessary therapeutic interventions.