This paper discusses the diagnostic and therapeutic approach to a patient with concomittant serious clinical conditions such as bilateral nephrolithiasis, and possible dual primary malignancies of the kidney and the urinary bladder.

A 62-year-old male presented with gross hematuria. Radiographic imaging revealed a large urinary bladder mass, bilateral hydronephrosis due to obstructive nephrolithiases, and a left solid renal mass. After appropriate cardiopulmonary optimization, the authors opted to do a preliminary transurethral resection of the bladder tumor. This was followed by staged therapies with right ultrasound-guided PCNL; a left partial nephrectomy with nephrolithotomy, and radical cystectomy with ileal conduit. Unfortunately, the patient did not survive the multiple surgeries and expired. The chronology of the various therapeutic procedures in cases of synchronous serious clinical conditions of the urinary tract such as nephrolithiasis, renal and bladder neoplasms need to be individualized and will dictate the outcome of the entire therapy.