A 52-year-old male patient presented with bilateral loin pain of four months' duration. Twenty years before, he had had surgery for kidney stone disease. An abdominal examination revealed a scar from the previous surgery on his left side. Investigations showed microscopic haematuria with no growth on urine culture. His serum creatinine and haemoglobin were normal. A plain abdominal X-ray of the kidneys, ureter, and bladder (KUB) showed bilateral renal stones. The detailed renal anatomy and the extent of renal stones were delineated by computed tomography (CT). The present case was managed by open surgery rather than PCNL due to the surgeon's preference. In addition, it has been shown that staghorn calculi are associated with a lower stone-free rate after percutaneous nephrolithotomy.2 A patient with staghorn calculi in a horseshoe kidney was 45 times more likely to have a lower stone-free rate after percutaneous nephrolithotomy than a patient without staghorn calculi in the horseshoe kidney. Therefore, open surgery still has a role in the treatment of horseshoe kidneys with staghorn calculus when indicated.