Percutaneous Nephrolithotomy (PCNL) has been the surgical choice in the treatment of patients with large stones and stag horn calculi. Though PCNL can be safely performed in all patients, very few specific reports are available on its role in the high-risk preoperative patients. This study is aimed to analyze its feasibility and safety in high-risk patients. The records of 38 patients who underwent PCNL procedures from January 2012 to December 2014 at our institution were analyzed. Patients were divided into high-risk and low risk preoperative groups as per American Society of Anesthesiologist scores of I & II (n=25) and III or IV (n=13). Co morbidities are more frequently seen in the high-risk group than in the lowrisk group (3.0 vs 1.7). No significant difference was noted in the mean cumulative stone size for single or multiple stones in either group. Average operative time was 108 and 94 minutes and the average hospital stay was 6.8 and 4.1 days in both groups of patients. Whereas, no significant difference was seen in estimated blood loss (145 and 136mL). The overall complication rate was similar between the high-risk (17.5%) and low-risk (15.2%) groups. The stone –free rate for the highrisk group was 75% compared to 88% in low-risk group. To conclude, though high-risk patients had longer operative anesthesia time and average hospital stay than low risk patients both groups had similar mean operative times, intraoperative blood loss, and complication rates indicating that performing PCNL could be safe in the high-risk preoperative individuals.