I performed Rt mini-ECIRS, Lt RIRS, cystolitholapaxy and HoLEP in a single session for bilateral renal stones, bladder stone and large prostate because I just worried about the risk of prolonged discontinuation of aspirin and plavix for this 72-year-old patient with cardiac 3 vessels disease. Actually 4 operarions in a single session are not my usual practice... Fortunately 170 min of operative time was tolerable to my patient's heart.

[Preoperative images]

- bilateral stones

- Enlarged prostate (43g) with urodynamically-proven bladder outlet obstruction

[Intraop images]

Rt mini-ECIRS, Lt RIRS

Rt mini-ECIRS, Lt RIRS

cystolitholapaxy and HoLEP

[Postoperative image-stone clear]