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ABSTRACT: The prone position has been widely adopted in conventional percutaneous nephrolithotomy (PCNL). Following its introduction in 1998, we changed our routine practice of PCNL from the prone to the supine position, which had numerous benefits and was safe and effective. Tract formation and stone fragmentation and retrieval were accomplished with the patient supine. We report our experience with 62 patients (67 renoureteral units) treated in the supine position and describe the technique in detail. The primary stone clearance rate was 76%, and the mean number of sessions of PCNL was 1.3. There was no procedure-related major complication. There were also no splanchnic injuries. One kidney loss (emergency nephrectomy for control of hemorrhage) was noted but was not directly related to the procedure (profuse bleeding after accidental traction on the balloon nephrostomy tube by the patient 1 week after PCNL). Modification of positioning was made to suit the body build of Chinese patients. There are several advantages to the supine position for the patient and the urologist, with greater versatility of stone manipulation along the whole upper urinary tract. There are a few limitations of the supine position, but they can be overcome. Performing PCNL with the patient in the supine position is a sound alternative to the conventional prone position.