Objective: To compare the therapeutic effects of visual standard channel combined with visual superfine precision puncture channel or super-mini percutaneous nephrolithotomy (PCNL) on multiple renal calculi. Methods: A total of 86 patients with multiple renal calculi were retrospectively analyzed. According to different working channels, they were divided into a visual puncture channel group (visual puncture standard channel combined with visual superfine precision puncture channel, n=38) and a conventional puncture channel group (standard channel combined with super-mini channel, n=48). The two groups were compared in terms of time of channel establishment, surgical time, reduction of hemoglobin, phase I clearance rate of calculi, and surgical complications. Results: The time of establishing visual/conventional standard channel was (4.5 +/- 1.5) min vs. (6.8 +/- 1.8) minutes (t=6.326, P=0.000), and the time of establishing visible superfine/super-mini channel was (4.52 +/- 0.97) minutes vs. (7.76 +/- 1.35) minutes (t=2.017, P=0.000). The surgical time was (92 +/- 15) minutes vs. (115 +/- 13) minutes (t=26.640, P=0.000). The Phase-I clearance rate was 86.7% (33/38) vs. 87.5% (42/48) (x(2) =0.008, P=0.928), the reduction of hemoglobin was (12.21 +/- 2.5) g/L vs. (13.22 +/- 3.5) g/L (t=2.017, P=0.137), the blood transfusion rate was 13.16 (5/38) vs. 8.33% (4/48) (x(2)=0.006, P=0.941), the postoperative fever rate was 7.89% (3/38) vs. 14.58 (7/48) (x(2)=0.006, P=0.941), and the hospitalization stay length was (6.5 +/- 1.0) vs. (6.6 +/- 1.2) (t=0.413, P=0.681). There were no significant differences between the two groups. Conclusion: Both surgical approaches had high clearance rates of multiple renal calculi, safety, reliability and few complications. However, compared with the conventional puncture channel, the visual one was easy to operate and dramatically shortened the time of establishment, thus being safer and more accurate.