Background: Percutaneous nephrolithotomy (PCNL) is a standard technique for the treatment of upper urinary stone disease. Stone clearance during PCNL depends on the precise placement of a percutaneous tract that provides direct access for stone manipulation. We retrospectively evaluated the safety and outcome of the supracostal and Subcostal approach for the percutaneous removal of renal stones. Methods: Retrospective study was conducted in the department of urologyfrom September 2018 To March 2020. Patient with complains of loin pain, haematuria, fever, nausea, vomiting, suspected to have urolithiasis were documented. General phyiscal examination, spine and gentiourinary examination finding were documented. Patient diagnosed to have large renal calculus, upper ureteric calculus, PUJ calculus and calyceal calculi were included in this study. Results: Total 123 Patients had undergone PCNL during the study period. 53cases of Supracostal and 70 Cases Of Subcostal PCNL. Demographic variables were insignificant in both supracostal and subcostal puncture group. Most common stone distribution was large renal calculi, which was around 34%. 55% patients had stone size between 1-2 cm,whereas mean stone size was 2.05 cm. Duration of surgery and hospital stay was almost comparable in both group. SFR in supracostal group was comparable with subcostal group. Overall SFR in over study was 92 %. Perioperative bleeding was a most common complication seen around 13.2 % in supracostal puncture and 3 % subcostal puncture group. 10 % required blood transfusion in supracostal puncture, whereas in subcostal puncture was 3 %. Atelectasis (7.5 %) and pneumothorax (3.7 %) were the intrathoracic complications seen in supracostal puncture group. Conclusions: Supracostal puncture technique is a safe feasible procedure with minimal morbidity when compared with subcostal technique. The intrathoracic complications can be avoided by proper planning of puncture site, on or lateral to posterior axillary line during expiration.