Breaking Stones Across Boundaries: PCNL in Cross-Fused Renal Ectopia-a Rare Anatomical Challenge

Background: Cross-fused renal ectopia (CFRE) is a rare congenital anomaly in which both kidneys are located on the same side of the midline and fused together, often resulting in abnormal renal orientation and vascular supply. The occurrence of nephrolithiasis in such patients is not uncommon due to anomalous drainage and stasis, but surgical management poses unique challenges. Percutaneous nephrolithotomy (PCNL) in CFRE is rarely reported in literature due to technical complexity. Case Presentation: We report a case of a 65 year-old male presenting with [flank pain and intermittent hematuria, found to have a large renal calculus in a cross-fused ectopic kidney located on the left side. Imaging with contrast-enhanced CT and 3D reconstruction delineated the fused moiety, stone burden, and anomalous vasculature. A carefully planned PCNL was performed under fluoroscopic guidance in the supine position, achieving complete stone clearance with no intraoperative complications. Conclusion: PCNL in patients with cross-fused renal ectopia is feasible and safe with meticulous preoperative planning and imaging. Awareness of anatomical variations and individualized surgical strategies are critical to achieving optimal outcomes in such complex cases.