Purpose <p>Super-mini percutaneous nephrolithotomy (SMP) is a promising minimally invasive approach for upper tract stone management. However, evidence on its performance using suction sheath and pneumatic lithotripsy in resource-limited setting remains scarce. The main objective of this study is to examine the efficacy and safety of SMP done exclusively with this combination.</p> Methods <p>Prospectively collected data of all eligible SMP cases done in two centers between March 2021 and February 2025 were retrospectively processed. After de-identification of the final data, descriptive and analytical statistics were used as appropriate. Regression models were then constructed to identify risk factors for complications.</p> Results <p>Total of 324 prone SMP procedures were performed on 319 patients. The mean stone volume, operating time and fluoroscopy beam-on time were 1473 mm³, 38&#xa0;min, and 145&#xa0;s respectively. The mean hemoglobin drop was 1.2 ± 0.9 gm% with 2.1% of patients requiring blood transfusion. Overall, stone-free rate was 96.9% at 1-month follow-up, minor complications (Clavien-Dindo ≤ II) being 13.4%, and major complications (Clavien-Dindo &gt; II) being 2.2%. Multinomial regression analysis revealed operating time &gt; 40&#xa0;min, positive urine culture, and access through 10th intercostal space as significant predictors of complications. Limitation includes retrospective design, lack of computerized tomography for confirming stone-free status, and lack of intra-renal pressure monitoring.</p> Conclusion <p>SMP using a combination of suction sheath and pneumatic lithotripsy is a safe and effective treatment option for selected cases with upper tract lithiasis in resource-limited settings, with high stone clearance and acceptable complication rates.</p>