Abstract
INTRODUCTION AND IMPORTANCE: Urolithiasis is a common condition, but management becomes challenging in patients with recurrent stones, anatomical variations, or a history of multiple interventions. CASE PRESENTATION: A 56-year-old man with bilateral kidney stones and a duplex collecting system had a long-standing history of flank pain and had undergone several procedures, including ESWL, URSL, and PCNL. Most recently, he was presented with a right-sided renal stone. CLINICAL DISCUSSION: Urolithiasis in patients with duplex renal systems can lead to recurring stones, making treatment more complex. Imaging like ultrasound and CT scans help in diagnosis, and procedures like retrograde intrarenal surgery (RIRS) are effective for removal and good surgical outcome. With stone analysis and follow-up care, including hydration and dietary changes, recurrence can be minimized. CONCLUSION: This case highlights the challenges of managing complex, recurrent urolithiasis in a patient with a duplex collecting system.