Synchronous calculus and malignant diseases of the kidneys pose a serious therapeutic dilemma. The choice, timing and sequence of surgery of either kidney will always be a subject of debate. We present here our experience on the successful management of both conditions in a minimally invasive manner.

A 51-year-old asymptomatic male, who was being considered as a stem cell donor to his daughter, was incidentally diagnosed through and ultrasound, and later with a non-contrast CT, to have a 4.2cm right staghorn calculi and a 3.8 x 4.2 x 4.4 cm left lower polar renal mass. His creatinine was 1.35mg/dl (eGFR 60.) In order to optimize his renal function prior to the management of the renal mass, we performed an upper pole prone PCNL on the right, rendering him stone-free with no complications. After four weeks, we performed a laparoscopic partial nephrectomy (via enucleation) with an ischemia time of 30 minutes with minimal blood loss. The patient recovered fully.

Final histopathological analysis revealed clear cell renal carcinoma with no adverse features and negative margins. Three months later, he had a serum creatinine of 1.38mg/dl (eGFR 59.) Follow up CT urogram showed no calculus on the right with no tumor recurrence on the left.

The management of synchronous calculus and malignant lesions of the kidneys require A thorough preoperative evaluation and planning. Both of these conditions may be managed with minimally invasive methods to maximize renal preservation while providing benefits of better cosmesis, less postoperative pain and shorter convalescent period.