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Purpose In this study, we present our initial experience with a real one-step dilatation technique and evaluate the safety and efficacy of this novel solution for creating nephrostomy tract for percutaneous nephrolithotomy (PCNL).Patients and methods In this prospective non-randomized study, enrolled 57 and 114 cases who is scheduled to undergo PCNL at our instituion from January 2012 to may 2012 and from June 2012 to June 2013 respectively.The 57 and 114 patients were assigned to undergo sequential fascial dilatation (sequential group) or one-step nephrostomy tract dilatation (one-step group) technique for creating nephrostomy tract in PCNL procedure respectively.Tract creation time, renal hemorrhage, overall renal function, tract dilatation failure and collecting system perforation were compared between the two groups.Results The one-step group had a significantly shorter mean (SD) tract creation time(1.9±0.4 vs 5.4±0.9 min, P<0.001) and lower mean (SD) decrease in hemoglobin concentration (5.6±3.1 vs 7.9±3.9 g/ L, P=0.0004) compared with sequential group, respectively.There were no significant differences in mean (SD) value changes of pre-operative and post-operative serum creatine concentrations (5.0± 14.8 vs 4.5± 11.4 μmol/L, P=0.261) for one-step and sequential groups.No major complications such as tract dilatation failure or collecting system perforation happened in both groups.Conclusion The one-step nephrostomy tract dilatation technique is a simple, safe and efficacious solution for creating the nephrostomy tract.It renders less time-consuming and less renal hemorrhage as compared with sequential fascial dilatation technique.Further studies are needed to demonstrate whether this novel nephrostomy tract dilatation technique may become a new standard for establishing nephrostomy access tract.