Percutaneous nephrostomy (PN) in newborns and young infants presents unique challenges. Twenty-six consecutive PN procedures in 18 patients were retrospectively reviewed. Fifteen procedures were performed with the conventional micropuncture technique. The modified technique describe herein was used in 11 procedures. Depending on whether there is obstruction and whether the obstruction is at the ureteropelvic junction level or distal to it, the technique selected will vary.