Staged Flexible Transurethral Lithotripsy After Robot-Assisted Partial Nephrectomy for Concomitant Renal Cell Carcinoma and Ipsilateral Nephrolithiasis: A Case Report

The optimal treatment sequence for patients with renal cell carcinoma (RCC) and concomitant ipsilateral renal calculi remains unclear. A 66-year-old man presented with a 45-mm left cystic renal mass adjacent to the collecting system and a 9-mm ipsilateral renal calculus. Because the stone was asymptomatic and oncological treatment was prioritized, robot-assisted partial nephrectomy (RAPN) was performed first. Minor collecting system entry occurred and was repaired intraoperatively. Histopathology revealed papillary RCC, pT3a, with negative surgical margins. Three months after RAPN, stone migration caused mild hydronephrosis without infection or urine leakage. Flexible transurethral lithotripsy (fTUL) was safely performed 4 months after RAPN using a low intrarenal pressure strategy. No perioperative complications occurred. Staged low-pressure fTUL after RAPN with collecting system repair may be a feasible treatment strategy in selected patients with concomitant RCC and ipsilateral renal calculi.