In a retrospective analysis percutaneous ultrasonic lithotripsy and anatrophic nephrolithotomy for staghorn stones were compared to evaluate morbidity. In 46 patients treated percutaneously and 29 patients treated by open surgery, the procedure time, success rate, complication rate, length of hospitalization, disability period, and amount of analgesics needed in the postoperative period were analyzed. 5 patients treated during the learning period were not considered for this study, no matter whether they were treated by open or percutaneous surgery. Complete removal of all stone fragments was achieved in 73.8% of the patients treated percutaneously. Calculi were removed successfully in 82.1% of the patients submitted to anatrophic lithotomy. The group treated percutaneously showed shorter procedural time (mean 120 versus 210 min), shorter hospitalization period (5 versus 7 days), less need for analgesics (mean 1.6 versus 4.7 doses per patient), and an earlier return to normal physical activities (9 versus 43 days). Among the patients who underwent open surgery, 14 (50.0%) required additional interventions to treat complications. Although in the percutaneous group 28.5% required more than one percutaneous intervention, the overall complication rate per surgery of 20.0% was significantly lower, with no need for open surgery. Percutaneous nephrolithotomy proved to be of significantly lower morbidity than anatrophic lithotomy.