Two pelvises, one stone: A different approach for management of calculi in a duplex renal collecting system

Duplex renal collecting systems are a common congenital abnormality. Management of renal calculi in patients with this abnormality is complex. We describe a patient with a duplex collecting system presenting with a renal calculus. Initial flexible ureteroscopy failed to reach the collecting system containing the stone due to inability to visualize an additional ureteric orifice. The patient then underwent percutaneous puncture of the stone containing moiety, followed by antegrade stent insertion. This allowed for guidewire- assisted passage of a ureteroscope into the duplex collecting system, where the calculi were identified and fragmented.