Objective：To compare the efficacy of the percutaneous nephrolithotomy（PCNL） in the treatment of upper urinary calculi in different accesses. Methods：Totally 1438 cases underwent PCNL from October 2009 to June 2017 were reviewed retrospectively. The cases were divided into staghorn calculi group，multiple stones group，single renal calculi group（combined or not combined with ureteral calculi） and ureteral calculi group. The efficacy of PCNL in different accesses was compared in the aspects of the first period calculus complete clearance rate，operation time and intraoperative and postoperative complications. Results：For the staghorn calculi group，there were significant differences in the first period calculus complete clearance rate and the operation time（P<0.05） between upper accesses and middle/lower accesses. For the multiple stones group，there were significant differences in the first period calculus complete clearance rate and the operation time. For the single renal calculi group（combined or not combined with ureteral calculi） ，there was no significant difference in the first period calculus complete clearance rate，but there were significant differences in the operation time. For the ureteral calculi group，there was no significant difference in the first period calculus complete clearance rate and the operation time（P >0.05）. The puncture success rate was 100% to all the cases. Conclusion：The first period calculus com－plete clearance rate is higher and the operation time is shorter for staghorn calculi and multiple stones through upper pole access. So we suggest to treat the staghorn calculi and multiple stones through upper pole access.