Anatrophic nephrolithotomy and pyelolithotomy for dual staghorn calculi in bifid collecting system

A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly involves a common distal ureter. This is usually asymptomatic and is predominantly an incidental diagnosis, nevertheless, is a potential risk factor for urolithiasis formation. Current surgical management of larger staghorn calculi favours percutaneous nephrolithotomy (PCNL) over traditional open surgery, however for multiple calculi and complex anatomy PCNL would require multiple punctures, with increased risk of bleeding, pleural injury, sepsis and ultimately failed stone clearance. We describe the case of a 71-year-old female with multiple calculi in bifid anatomy. A single open approach, aided with cold-ischaemia was successfully utilized in this context.