Objective  To investigate the safety and efficacy of visual puncture system in percutaneous nephrolithotomy (PCNL) in the treatment of kidney stones without hydronephrosis.Methods   The clinical data of 22 adult kidney stones patients without hydronephrosis underwent PCNL by visual puncture system from December 2017 to November 2018 were analyzed. All cases were performed by urinary non-contrast computer tomography (CT) scan before the surgery and no hydronephrosis were detected. First ureteral stent was indwelled in lithotomy position and used to induce artificial hydronephrosis. Under the guidance of ultrasound, visual puncture system was used to puncture the target calyx. According to the size of stones and calyceal, we chose F4．8 micro-PCNL, F12 ulrta-mini-PCNL or F16/F18 mini-PCNL and built multi-channel by visual puncture system when necessary.Results  Twenty-two patients received 23 lateral lithotripsies, and 29 working channels including second channel were built. Successful rate of one-time puncture was 79．3%（23/29）.The operation time was 35-130 min, with an average of (67．0±30．4)min. The average decrease of hemoglobin was (6．4±4．7)g/L. No cases for transfusion or arterial embolization and only 2 cases had a fever. No collecting system perforation or abdominal visceral and pleural injury occurred. One-stage stone free rate was 82．6%.Conclusions   Establishing working channels by visual puncture system are safe and quick. It is safe and has high stone free rate in the treatment of kidney stones without hydronephrosis, especially for inexperienced young doctor.