Aims: To compare between supine and prone percutaneous nephrolithotomy (PCNL) in the management of renal stones regarding stone free rate, operative time and fluoroscopy time. Methodology: A retrospective analysis was performed in the period between January 2019 and January 2021 for patients underwent PCNL for renal stones 2 cm or more. They were 77 patients divided into two groups, group (A) prone 38 patients and group (B) supine 39 patients. Results: the study demonstrated a significant difference in operation time which was (92.5 ± 24.85 min.) in prone group & (68.3 ± 22.90 min.) in supine group with p-value (<0.001), also significant difference in fluoroscopy time which was (258.0 ± 57.19 sec.) in prone group & (166.9 ± 46.60 sec.) in supine group with p-value (<0.001) with shorter operation and fluoroscopy time in the supine than the prone. The study has also demonstrated that there is no statistically significant difference between the two groups as regarding to stone free rate. Conclusion: in patients with renal stones, 2 cm or more, supine PCNL has proved to be superior to prone PCNL as regarding operative and fluoroscopy time but no difference as regards stone free rate. However, Urologists should be familiar with the differences in the positions and be able to use the method appropriate for each patient.