A Single-Session Robotic-Assisted Approach for Renal and Bladder Calculi in a Pancake Kidney: A Rare Case Report

Abstract

Background:
Pancake kidney is an exceptionally rare congenital renal fusion anomaly characterized by complete medial fusion of both kidneys into a single discoid pelvic mass. It is often associated with abnormal rotation and atypical vascular supply. The coexistence of renal calculi and vesical calculus in a pancake kidney is exceedingly uncommon. Management of urolithiasis in this anomaly is surgically challenging due to distorted renal anatomy, short ureters, and limited percutaneous access.

Case Report:

A 27-year-old male presented with suprapubic pain, dysuria, and intermittent haematuria for one week. Imaging revealed a pelvic pancake kidney with two non-obstructing renal calculi and a large bladder stone. Due to severe mucosal edema preventing identification of the ureteric orifices during cystoscopy, a single-session robotic-assisted laparoscopic pyelolithotomy combined with cystolithotomy was performed. Pyelolithotomy and stone extraction were completed successfully followed by bladder incision and cystolithotomy. Retrograde double-J stenting and bladder reconstruction were performed. Follow-up low-dose CT at 6 weeks demonstrated complete stone clearance, and bilateral stents were subsequently removed.

Conclusion:
Robotic-assisted pyelolithotomy is a safe, effective, and versatile therapeutic modality for managing complex stone disease in patients with pancake kidney. Single-session combined management of renal and vesical calculi is feasible and minimizes morbidity.