Abstract
Retained encrusted ureteral stents represent a complex urologic problem, particularly in patients with limited healthcare access. We present a 28-year-old undocumented female with a 10-month retained ureteral stent who developed massive right-sided encrustation, including a 3 cm proximal renal stone near the renal pelvis and a 5-6 cm bladder stone, classified as FECal Grade IV-V. A single-session combined approach consisting of robot-assisted cystolithotomy, intraoperative ureteroscopy with stent exchange, and robot-assisted pyelolithotomy was performed successfully. Intraoperative ureteroscopy between operative phases confirmed ureteral clearance and enabled immediate stent placement without repositioning delay. This case supports the use of combined robotic approaches for high-grade disease and illustrates how structural barriers drive late presentation and increased surgical complexity.