Intercostal-space nephrostomies were created in 50 kidneys for removal of 17 staghorn, 9 calyceal, and 24 ureteral calculi. Complications were encountered in six [12%] of 50 patients. These included large pleural effusions in four patients and hydropneumothoraces in two patients. Four patients (8%) had chest tubes placed. The intercostal approach provides direct, straight access to both upper-pole and ureteral calculi as well as to the major portion of most staghorn calculi. Although the morbidity rate is slightly higher than for the more traditional approach via the subcostal lower pole or middle calyx complications generally can be avoided by using a working sheath and placing a large nephrostomy tube after the procedure.