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INTRODUCTION The use of fluoroscopy during percutaneous nephrolithotomy (PCNL) may lead to an overestimation of stone-free rates. The objective of this study is to demonstrate the feasibility of intraoperative CT-guided compared to standard of care (SoC) PCNL. PATIENTS AND METHODS Prospective feasibility study (20 patients undergoing a PCNL with an intra-operative CT scan between June 2017 and February 2020) and a retrospective study of an historical cohort (20 consecutive patients undergoing SoC PCNL between September 2015 and September 2016). All procedures were performed by an expert endo-urologist in a tertiary referral hospital. Follow-up was 6 weeks postoperatively. The primary goal is to investigate the practicality and the potential benefits and harms of intra-operative CT scanning during PCNL. Secondary outcomes are stone-free rate after 6 weeks follow-up, peri-operative radiation exposure, the need for postoperative imaging, peri- and post-operative complications. Statistical significance was considered at p < 0.05. RESULTS The initial stone-free rate in the CT scan group was 65% (n=13). In 25% (n=5) of patients, residual stone fragments were removed after the peri-operative CT scan. In the SoC group, 85% (n=17) of patients were thought to be stone-free peri-operatively. At 6 weeks follow-up, 80% (n=16) in the CT-scan group versus 50% in the SoC group (n=10) showed to be stone-free. Radiation exposure peri-operatively was higher in the CT-scan group. Complications were comparable between groups. Limitations of the study are the non-randomized design of the study and non-standardized follow-up imaging. CONCLUSION Intra-operative CT scanning during PCNL is feasible and gives a better estimate of any remaining stone fragments than we may expect based on fluoroscopy only.