Kidney stones are the most common urological condition worldwide, with rising prevalence. Bilateral cases present challenges such as longer surgery, anesthesia risks, and extended hospitalization. We report a case of a 59-year-old female with bilateral hydronephrosis and multiple stones, successfully treated with bilateral synchronous percutaneous nephrolithotomy (PCNL) at a district-level hospital in Surakarta, Indonesia. Using existing nephrostomy access and meticulous planning, the procedure minimized operative time and blood loss. Full stone clearance was achieved without complications, and renal function remained stable. Bilateral synchronous PCNL is a cost-effective, efficient option in selected patients, requiring advanced surgical expertise and well-coordinated care. © 2025 The Authors