Robot-assisted partial nephrectomy and nephrolithotomy for multiple lower pole calculi in an atrophic kidney

Open renal stone surgery has been largely replaced by retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL). However, when these methods fail to remove a stone or there are certain contraindications, such as pregnancy and obesity, laparoscopic, robotic or open surgery may still be indicated. In fact, robotic surgery has been increasingly used by urologists for different benign indications including chronic pyelonephritis, neglected ureteropelvic junction obstruction and renal tuberculosis. This article describes a case of robotic-assisted partial nephrectomy and nephrolithotomy for a large amount of small lithiasis in a non-functioning lower pole after failed stone clearance with a single use Boston ureteroscope owing to non-accessibility.