Analyzing Sushruta's technique from a modern perspective, this paper explores his detailed surgical approach to cysto-lithotomy, particularly the removal of bladder stones. Sushruta's methods, rooted in ancient Ayurvedic principles, are examined alongside contemporary surgical practices to highlight their relevance and evolution. Notably, the potential complication of efferent fiber injury during surgery, as described by Sushruta, leads to acute urinary retention and an inability to voluntarily void. This condition, known today as motor paralytic neurogenic bladder, results from disrupted motor innervation, impairing bladder function. By comparing these historical and modern understandings, the paper aims to bridge the gap between ancient wisdom and modern medical advancements.The process begins with careful preparation, including the application of pressure and lubrication to mobilize the stone into a palpable position. The surgical approach involves a precise incision near the perineal raphe to facilitate stone extraction, ensuring careful management of surrounding anatomical structures to prevent complications such as urinary fistulas, bladder rupture, and damage to the urethra. The use of specialized instruments, like the Agravakra (curved forceps), is recommended for stone removal, and attention is given to minimizing the risk of stone fragmentation and recurrence. For females, the incision is directed cephalad to avoid injury to the uterus, while in males, particular care is required to protect the trigonal region of the bladder. Postoperative management includes catheterization, effective drainage techniques, and the use of a decoction from latex trees to clear residual fragments and blood from the bladder. Additionally, the paper emphasizes the importance of preserving vital pelvic structures, including the hypogastric nerve and pelvic plexus, to avoid long-term complications such as urinary retention, retrograde ejaculation, and impotence. By following these rigorous procedures, the lithotomy aims to ensure safe removal of the calculus while minimizing the risk of postoperative morbidity and preserving urinary and sexual function.