Percutaneous nephrolithotomy of a staghorn calculus in a patient with renal angiomyolipoma

Renal angiomyolipoma (AML) is the most common benign renal tumor and is prevalent in around 0.2%–0.6% of the population. Its main associated risk is bleeding. It is uncommon that AML presents simultaneously with a staghorn calculus requiring percutaneous nephrolithotomy (PCNL) for stone resolution with only two previously reported cases. In this case, we present a 41-year-old female patient who presented with a 2-year complaint of left flank pain and hematuria. Following investigation, the patient had a large staghorn calculus in the left kidney and an incidental finding of a large AML in the ipsilateral kidney. A single puncture was made under ultrasound guidance, to avoid any form of injury to the AML, and complete stone clearance was achieved through a single tract only. Although the concurrence of AML with a renal calculus requiring PCNL presents a clinical challenge, using ultrasound guidance for stone clearance is a safe and successful means of management with minimal exposure to radiation.