Flexible Ureterorenoscopy and Robotic Surgery Erdal Alkan, MD, Oguz Ozkanli, MD, Mevlana Derya Balbay, MD Department of Urology, Memorial S ¸is ¸li Hospital, Okmeydanı, S ¸is ¸li-, ˙ Istanbul, Turkey (Drs. Alkan, Balbay). Department of Anesthesiology, Memorial S ¸is ¸li Hospital, Okmeydanı, S ¸is ¸li-, ˙ Istanbul, Turkey (Dr. Ozkanli). ABSTRACT Introduction: We present the feasibility of flexible ureteroscopic lithotripsy concomitant with robot-assisted radical prostatectomy and bilaterally extended pelvic lymphadenectomy. Methods: Two patients underwent flexible ureteroscopic lithotripsy, robot-assisted radical prostatectomy, and pelvic lymphadenectomy at one anesthesia session. Flexible ureteroscopic lithotripsy was performed first. Later, robotic prostatectomy and lymphadenectomy were performed with the patient in the exaggerated 30° Trendelenburg position. All relevant preoperative clinical details, intraoperative details, problems encountered, complications, hospital stay, postop- erative recovery, pathologic findings, and clinical follow-up were assessed. Results: Both patients were discharged uneventfully from the hospital on the third postoperative day. In the postoperative first month, the double-J stents were removed. Both patients were prescribed hormonal treatment and were also referred for radiotherapy due to final pathology and postoperative prostate-specific antigen levels. Conclusion: Combining robot-assisted radical prostatectomy and flexible ureteroscopy is feasible in patients with urinary stone disease and prostate cancer concomitantly. Key Words: Flexible ureterorenoscopy, Urolithiasis, Robotic surgery, Prostate cancer, One anesthesia session. INTRODUCTION Urinary stones are one of the most common conditions that affect the kidneys, 1 and the lifetime risk of urolithiasis in the general population is 13% in men and 7% in women. 2 Although there are various treatment modalities such as percutaneous nephrolithotomy, shock wave lith- otripsy, open surgery, and ureteroscopic lithotripsy for kidney stone disease, retrograde intrarenal surgery with flexible ureteroscope has been found recently to have a good success rate for the management of renal stones. Prostate cancer (PCa) is the most common male cancer in developed countries 3 and can be completely treatable when it is organ confined. In this stage, the most preferred treatment is radical prostatectomy (RP). Open RP, laparo- scopic RP, and robot-assisted RP are surgical options for the management of localized PCa. Herein, we report 2 patients with left kidney stones and localized PCa who underwent left flexible ureterorenoscopic lithotripsy (FURS-L), robot-assisted radical prostatectomy (RARP), and robot-assisted bilateral pelvic lymphadenectomy (RABPL) at one anesthesia session. MATERIALS AND METHODS Between February 2012 and September 2012, 2 patients with PCa and left kidney stones were admitted to our clinic. Biochemical tests including kidney function tests, hemogram, alanine aminotransferase, aspartate amino- transferase, and alkaline phosphatase all demonstrated normal limits in both patients. Because of their elevated prostate-specific antigen (PSA), levels both patients were investigated with bone scintigraphy and abdominopelvic computed tomography (CT) scans for staging purposes (Table 1). The CT scans showed concomitant left kidney stones in addition to localized PCa. Patients were in- formed of their stone disease and its complications, as well as treatment options, including FURS-L, and both Citation Alkan E, Ozkanli O, Balbay MD. Flexible ureterorenoscopy and robotic surgery. CRSLS e2014.00107. DOI: 10.4293/CRSLS.2014.00107. Copyright © 2014 SLS This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 3.0 Unported license, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. Address correspondence to: Erdal Alkan, MD, Memorial S ¸is ¸li Hospital, Department of Urology, Okmeydanı, 34385 S ¸is ¸li-, ˙ Istanbul, Turkey. Telephone: (+90) 212-314-6666, Fax: (+90) 212 -314-6608, E-mail: eralkan@hotmail.com 1 e2014.00107 CRSLS MIS Case Reports from SLS.org CASE REPORT