Percutaneous nephrolithotripsy (PCNL) is today gold standard for the management of complex urinary calculi. Over its lifespan this surgery has been subjected to multiple modifications and variants: for example, the anatomical positioning of the patient is still under controversy, especially the opposition amongst the prone and supine approaches, the two most common patient positions currently used for PCNL. Our objective was to review the literature and to discuss advantages and drawbacks from either technique.