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Patients with skeletal deformities represent a challenge during surgical management of renoureteral lithiasis. We present a case of supine percutaneous treatment in a 24-year-old female with spastic tetraparesis and complex skeletal deformity. A diagnosis of left ureterohydronephrosis caused by a 7mm distal ureteral calculus and 18mm left renal pelvis lithiasis was established. A lower pole ultrasound-fluoroscopy-guided percutaneous nephrostomy tube was inserted into the dilated pyelocaliceal system for the immediate relief of the obstructive nephropathy. Afterwards, a definitive approached with a mid pole puncture was performed. The pyelic stone was removed using a rigid nephroscop and a Swiss lithoclast for stone fragmentation. Then, anterograde flexible ureteroscopy combined with holmium: YAG laser was used in order to approach the ureteral stone for intracorporeal lithotripsy. The fragmented stones were passed down to the bladder by irrigation and a 6 nephroureteral catheter was left in place at the end of the procedure. [ABSTRACT FROM AUTHOR]