Purpose: To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones. Patients and Methods: Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO(2)) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted. Results: SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p=0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p>0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p>0.05). Duration of surgery was significantly shorter in the RIRS group (p=0.001). Stone size was significantly higher in the PNL group (p=0.013). Conclusion: Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.