Purpose: The aim of this study is to evaluate overnight ureteral catheterization vs nephrostomy tube for urinary diversion in patients undergoing percutaneous nephrolithotomy (PNL) under spinal anesthesia. Materials and Methods: Patients were enrolled using block randomization between February 2016 and July 2016. Patients with renal stones >2 cm confirmed via noncontrast-enhanced CT were included. All patients underwent PNL under spinal anesthesia. Group 1 refers to patients who had a nephrostomy tube following PNL, whereas group 2 refers to overnight ureteral catheterization. Those who refuse spinal anesthesia, <18 years of age, >70 years of age, and anomalous kidneys (ectopic pelvic kidney, horseshoe kidney, etc.) were excluded. In group 1, nephrostomy tube (14F) was removed 48 hours after surgery, whereas the ureteral catheter (6F) was removed at postoperative 12th hour in group 2. Visual analogue scores (VASs) at 24th hour and mean narcotic analgesic (tramadol) amounts were compared. Results: There were 30 patients in both groups. Mean age, mean body mass index, and stone area were not significant between groups (p > 0.05, for all). With regard to operative measures, mean duration of surgery, mean number of accesses, and mean drop in Hb levels were comparable. Besides, mean hospitalization period in group 1 was 68.8 +/- 12 hours, whereas it was 54.5 +/- 10 hours in group 2 (p < 0.001). No patients in either group needed transfusion. Stone-free rates were similar in both groups (83% vs 90%, p = 0.391). Mean 24th hour VAS was 6.17 +/- 1.4 in group 1 and 3.37 +/- 1.4 in group 2 (p < 0.001). Also, there was a statistically significant difference in mean tramadol requirements between groups (181.67 +/- 56.45 vs 86.67 +/- 57.13, groups 1 and 2, respectively). Conclusion: In patients undergoing PNL under spinal anesthesia, using an open-ended ureteral catheter to be removed at early postoperative period reduces analgesic requirement and duration of hospital stay without compromising surgical outcomes and complication rates.