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Purpose: Treatment of staghorn calculi in patients with neurogenic bladder is complex and requires special consideration. In this article, we explore the current literature on this topic and give insights from our own practice. Recent Findings: Stones appear to be more common in patients with neurogenic bladders for a variety of reasons including increased risk with urinary diversion, bladder augmentations, or other genitourinary (GU) reconstruction, higher spinal cord lesions, and presence of bacteriuria. Given high rates of bacteriuria, perioperative antimicrobial regimen should be determined by preoperative urine culture and stone culture while taking into account organisms which typically grow in these cultures including E. Coli and gram-negative rods, Enterobacter, Proteus, and Pseudomonas. One should be aware of the increased risk of funguria in this patient population as well and treat as indicated. Finally, rates of stone recurrence are higher in this patient population as well. Close follow up with identification and aggressive treatment of risk factors for stone recurrence is imperative. Summary: Although there are special considerations, PCNL is safe and effective in patients with neurogenic bladder and staghorn calculi and should be pursued to achieve stone free status when possible. [ABSTRACT FROM AUTHOR]