Background:Percutaneous nephrolithotomy (PCNL) is a widely used minimally invasive procedure for the management of large, complex, or staghorn renal calculi. It offers higher stone-free rates compared to extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy. However, PCNL is associated with complications such as bleeding, infection, and organ injury, which may impact patient outcomes. This study aims to evaluate the frequency, nature, and severity of complications associated with PCNL and identify potential risk factors. Methods:A prospective observational study was conducted in the Department of Urology and Renal Transplant Surgery, including 22 patients undergoing PCNL. Data on patient demographics, stone burden, operative details, and postoperative outcomes were collected. The incidence of complications was systematically analyzed, and findings were compared with existing literature. Results:The mean age of the study population was 46.27 years, with 59.10% of stones located in the left kidney. The most common stone location was the renal pelvis (45.45%). The majority of patients underwent 26Fr tract dilation (54.55%), with 86.36% requiring PCN placement. Postoperative fever (13.64%) and bleeding (4.55%) were the most common complications. Most patients (68.18%) were discharged on postoperative day 3 (POD 3). Conclusion:PCNL remains a safe and effective treatment for large renal stones with a low complication rate. Optimizing preoperative imaging, early nephrostomy removal, and selective use of mini-PCNL can improve patient outcomes. Further research is needed to refine perioperative protocols and minimize complications.