Abstract: Background: Large bladder stones can cause significant morbidity and typically require active interventions. Pneumatic lithotripsy using a perurethral nephroscope is a minimally invasive and cost-effective treatment option. This study aimed to evaluate the efficacy and safety of treating large bladder stones using a perurethral nephroscope combined with pneumatic lithotripsy. Methods: This cross-sectional study was conducted at Pabna Medical College Hospital and affiliated private hospitals from February 2020 to January 2025. Twenty-three patients with large bladder stones (³3 cm) were enrolled. All patients underwent stone fragmentation using pneumatic lithotripsy with a perurethral nephroscope. Operative time, hospital stay, catheterization duration, and complications were also documented. Data were analyzed using SPSS version 25.0, with significance set at p<0.05. Results: The mean age was 52 ± 12 years, and 87.0% of the patients were male. The average stone size was 4.1 ± 0.6 cm in diameter. The mean operative time was 48.5 ± 12.0 minutes, with an average hospital stay of 1.6 ± 0.5 days. All patients were stone-free after the procedure. Minor complications occurred in 26.1% of the cases, including hematuria (13.0%), urinary retention (8.7%), and fever or stricture (4.3% each). No major complications were noted. Conclusion: Perurethral nephroscopy with pneumatic lithotripsy is an effective, safe, and minimally invasive technique for managing large bladder stones, particularly in resourcelimited settings.