Abstract Background: Percutaneous Nephro-Lithotomy (PNL) is a well-established technique for removal of renal stones. Large and complex renal stones are difficult stones to deal with. Aim of Study: This study is to evaluate our results of PNL for treatment of large and complex renal stones concerning Stone Free Rates (SFR) and complications. Patients and Methods: From 2012 to 2017, four hundreds and four renal units with large and/or complex renal stones were subjected to PNL. Eighty nine percent were males and 11% were females. Average stone Surface Area (SA) was 872mm2. Results: Stone Free Rate (SFR) was 79% for cases sub-mitted to PNL alone and 88.4% for those managed with auxiliary procedures. Hospital stay ranged from 2 to 21 days (Av. 3.6 days). Overall complication rate was 8% and were managed conservatively. Conclusion: PCNL is a safe and effective procedure for management of large and complex renal stones. There was a significant decrease in overall stone free rate and increased complication rates with increased stone surface area. Stones >1500mm2 are difficult stones for any modality. Multimodal approach should be thought of for large and complex renal stones.