Stones in solitary kidney represent a management dilemma for the endourologist. The advantage of bilateral fully functioning kidneys is not present. Therefore, any insult to either the solitary kidney itself or drainage system can lead to significant morbidity. Key clinical objectives include maximum preservation of existing renal function, high stone clearance, and minimizing post-procedure complications. To date, there exists no Level 1 evidence on this subject. This systematic review serves to evaluate the safety and efficacy of percutaneous nephrolithomy for patients (adults only) with stones in a solitary kidney.