We report the case of a 43-year-old male presenting with left flank pain. Non-contrast enhanced CT imaging revealed bilateral nephrolithiasis with the following measurements: 2.8 x 1.7 x 1.8 cm pelvic stone (825 HU) and 1.2 x 1.4 x 1.48 cm lower pole stone (715 HU)on the left kidney; and 1.45 x 2.2 x 1.1 cm middle pole stone (576HU) and 1.5 x 1.0 x 1.3 lower pole stone (506 HU) on the right kidney. This report aims to: 1. Present a case of radiation-free Enhanced Super Mini Percutaneous Nephrolithotomy (eSMP) 2. Demonstrate a step-by-step approach in performing Enhanced Super Mini Percutaneous Nephrolithotomy (eSMP)

A radiation-free Enhanced Super Mini Percutaneous Nephrolithotomy (eSMP) on the left kidney was performed utilizing ultrasonographic imaging for survey, puncture and dilation during the procedure. It uses a Fr. 12 nephroscope scope 306mm in a specialized Fr. 18 sheath 160mm with a Y-port connected to a collection bottle and a suction machine creating a vacuum to assist in the evacuation of stone.

The surgery had an access time of 10 minutes and lithotripsy time of 53 mins. No intraoperative or postoperative complications occurred. The patient recovered uneventfully. The patient underwent a 2nd procedure on the right kidney 7 days after, and was rendered stone free.

Radiation-free Enhanced Super Mini Percutaneous Nephrolithotomy (eSMP) is a feasible and effective approach for large nephrolithiasis.