Percutaneous lithotripsy is an established, safe, effective method for the management of renal calculi. Obesity long has been associated with increased surgical morbidity and may eliminate a patient from shock wave treatment. We compared 44 obese patients to 226 nonobese patients undergoing percutaneous stone management. Stone number, location and total stone burden were comparable in the obese and nonobese groups. There was no significant difference between the groups in hospital time, operative time, fragment rate, access success rate or morbidity. Percutaneous procedures offer successful alternatives with low morbidity for patients with renal calculous disease.