Laparoscopic-assisted percutaneous nephrolithotomy for nephrolithiasis in a pancake kidney

Pancake kidney is an extremely rare renal fusion anomaly characterised by a single discoid parenchymal mass situated within the pelvic cavity. Due to its anomalous rotation and location, it is highly susceptible to urinary stasis, resulting in nephrolithiasis and infections. This report describes the clinical course and management of a man in his 20s who presented with chronic episodic lower abdominal pain and intermittent gross haematuria. Diagnostic imaging revealed a 2.5×2.2 cm obstructive calculus in the renal pelvis of a pancake kidney, causing significant hydronephrosis. Due to the unusual location in the abdominal pelvis, which predisposes to a high risk of bowel injury, the patient underwent a successful laparoscopic-assisted percutaneous nephrolithotomy. This approach allowed for safe bowel mobilisation and direct visualisation during renal access, resulting in a stone-free status without postoperative complications. The case highlights the necessity of tailored surgical strategies when addressing nephrolithiasis in the context of rare anatomical anomalies, emphasising the role of combined minimally invasive techniques in optimising patient outcomes and minimising surgical morbidity.