The treatment of renal calculi has undergone dramatic changes compared with all other aspects of urologic surgery. Improvements in fiberoptic technology and video systems combined with the advent of shock wave lithotripsy (SWL) virtually have eliminated the need for open stone surgery. Standard open nephrolithotomy or pyelolithotomy has been replaced by the advancing technologies of the minimally invasive era. Since the introduction of SWL into clinical practice, this technique rapidly has become the treatment of choice for most renal calculi. In some circumstances, however, percutaneous procedures, ureteroscopy, or even open surgery are the preferred treatment options. The following article describes the current treatment options for calyceal calculi and discusses management of those calyceal stones that remain controversial.