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A 50-year-old tetraplegic gentleman was referred with visible haematuria and recurrent urinary tract infections (UTI) presenting as behavioural difficulty. His past medical history includes diffuse brain injury following a motorbike accident, hypertension, BMI 41, performance status 4, and needing a hoist for transfer. CT showed bilateral staghorn complete calculi measuring the maximum length of 3 cm (left) and 4.2 cm (right) with 600 HU. Following best interest meetings, the patient communicated his unwillingness to proceed with PCNL or open surgery due to risks and opted for FURS. His bilateral staghorn stone was completely cleared simultaneously at his primary procedure after a total operative time of 190 min. He had no postoperative complications and was discharged with bilateral stents in situ. He had a second-look FURS 4 weeks later but only required washout of minimal dust and removal of bilateral ureteric stents. His stone analysis confirmed struvite stone. His haematuria, recurrent UTIs, and behavioural issues were resolved. His 6 months postoperative CTKUB showed a dust-free status. This report discusses the challenges of simultaneous bilateral staghorn clearance using FURS.
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