Giusti G1 , Proietti S1 , Pasin L2 , Casiraghi G.M. 2 , Gadda G1 , Rosso M1 , Kinzikeva E1 , Doizi S3 , Gaboardi F1 , Traxer O3 .

1 Department of Urology, IRCCS, Ospedale San Raffaele, Ville Turro Division, Milan, Italy

 2 Department of Anaesthesia and Intensive Care, IRCCS, Università Vita-Salute San Raffaele, Ospedale San Raffaele, Milan, Italy 

3 Department of Urology, Tenon Hospital, Pierre and Marie Curie University, Paris, France 

ABSTRACT

OBJECTIVE 

To report the first performance of simultaneous bilateral percutaneous nephrolithotomy (PNL) and flexible ureteroscopy (fURS) carried out in tandem by two different surgeons in a patient with bilateral medium size renal calculi, describing step by step details of the surgical technique. 

METHODS 

A 46-year-old man, affected with hyperparathyroidism, was diagnosed with asymptomatic bilateral medium size renal stones. An abdominal non-contrast CT scan revealed a left single kidney stone with a maximum diameter of 16 mm and two right renal stones located in the pelvis and in the lower calyx, of 21 and 19 mm in maximum diameter respectively. A bilateral simultaneous PNL on the right side and fURS on the left side was therefore carried out. 

RESULTS

The total operative time was 80 minutes. No intra or post-operative complications were experienced. On post-op day one the creatinine serum level was stable (0.7 mg/dl); he was discharged home 48 hours later. Ureteral stents were removed seven days after the procedure. At two weeks follow-up an abdominal NCCT showed a stone-free status and no changes in renal function were detected.