A 60 year gentleman, suffering from myelodysplatic syndrome presented with left flank pain. On evaluation there was a complete staghorn calculus in the left kidney. He had a history of left open pyelolithotomy 20 years ago. His coagulation profile was normal. PCNL was done through superior calyceal puncture, and complete stone clearance was achieved. Postoperative recovery was uneventful.
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