To evaluate how advancements in equipment, preoperative imaging, and calyceal anatomy understanding have revitalized standard percutaneous nephrolithotomy (PCNL) for large kidney stones (>2.5 cm) at a tertiary healthcare center, reducing complications and enhancing efficacy compared to historical benchmarks.

retrospective study analyzed 766 patients undergoing standard PCNL at a tertiary healthcare center from January 2018 to December 2023. Patients with stones ≥2.5 cm and complete records were included; incomplete data or external treatments were excluded. Data on demographics, stone characteristics, operative details, and outcomes were assessed

Mean age was 43.75 ± 16.0 years; 69.7% were male. Mean stone size was 3.8 ± 1.2 cm, with 46.7% complex. Using a 24 fr mean tract dilation size and 1.3 mean no. of punctures, operative time averaged 92.5 ± 20.3 minutes. Stone clearance reached 91.3%, with intraoperative bleeding in 6.8% (1.7% transfusion), a 16.4% complication rate (clavian dindo I-IV), and a pain score of 3.5 ± 1.1. Hospital stay was 3.6 ± 1.2 days

Modern standard PCNL, bolstered by technological and anatomical advancements, achieves high clearance (91.3%) with reduced morbidity, reaffirming its role for large stones despite mini-PCNL’s rise.