Although the supracostal approach is thought to increase the difficulties and patient morbidity of PCNL, it facilitates the management of certain urinary infirmities, such as UPJ obstruction, staghorn stone, upper pole stone, proximal ureteral abnormalities, impacted UPJ stone and upper calix diverticulum. Hereby the authors briefly comment on the technical aspects of the supracostal approach, and also discuss the possible complications of this technique and how to avoid them.