BackgroundIndonesia has a high incidence of kidney stone disease. Endoscopic procedures are the preferred first-line treatment, but' nephrolithotomy remains an option for large or complex staghorn calculi, particularly in resource-limited settings. This study aimed to determine factors associated with the success rate of open nephrolithotomy at a single tertiary center. MethodsThis retrospective study included 92 adults who underwent open nephrolithotomy at Wonogiri Regional General Hospital from January 2018 to December 2022. We analyzed demographic, laboratory, stone-related, and operative variables. Stone characteristics were assessed on preoperative non-contrast CT. Success was defined as complete stone clearance or residual fragments <4 mm on plain abdominal radiography (Blaas Nieren Overzicht, BNO) (KUB) on postoperative day 1. Associations were tested with simple binary logistic regression. Variables with p<0.25 were entered in a multiple logistic regression model. ResultsAmong the 92 patients, 59 were men and 33 were women, with a mean age of 53.25 ± 10.25 years. Surgery succeeded in 69 patients (75.0%), and complications occurred in 14 (15.2%). In simple logistic regression, female gender (OR 3.44, 95% CI 1.06–11.20; p=0.040) and multiple stones (OR 0.026, 95% CI 0.003–0.203; p=0.001) were associated with success. In multiple logistic regression, only stone number remained independently associated with success (aOR 0.029, 95% CI 0.004–0.230; p=0.001). ConclusionStone number was the only independent factor associated with the success of open nephrolithotomy. Patients with multiple stones had lower odds of success. This should guide preoperative planning and counseling.