A 54-year-old man with complex urinary anatomy as the result of previous surgery sustained a renal-vein injury during percutaneous nephrolithotomy for a staghorn calculus with a blood loss of 1.5 L. He was managed with antibiotics, bed rest, heparin, and a 28F nephrostomy catheter, which was withdrawn gradually as the tract sealed. This case highlights the importance of early diagnosis of this complication and the possibility of conservative management.