Percutaneous nephrostomy is a procedure in which access to the renal collecting system of a native (nontransplanted) or transplanted kidney is obtained through the skin, providing external drainage and/or a portal for additional minimally invasive procedures. Such additional minimal invasive procedures include nephrolithotripsy, ureteric stent placement, ureteric dilation, ureteric embolization/obliteration, and rendezvous procedures with cystoscopy. Percutaneous nephrostomy has been proven to be an effective and safe minimally invasive image-guided procedure. This article discusses the indications, techniques, imaging guidance modalities, and outcomes related to percutaneous nephrostomy. Extensions of the nephrostomy procedures, such as ureteric stent placement and nephro-ureteral stent placement are discussed in subsequent articles in this issue.