Cystine stones: the impact of new treatment.
The hardness and frequent recurrence of cystine stones present a special challenge to the urologist. In this study, 15 cystinuric patients (11 males, 4 females; mean age 36 years, range 17-54) were treated and followed up over a period of 30 months (range 2-40). Most patients had previous history of open surgery. The diagnosis of cystinuria was confirmed by metabolic studies and infrared spectrometry of stones. Over the follow-up period recurrence was observed in 23 instances in 11 patients, leading to 38 "stone treatments" on 74 cystine stones. The percutaneous approach was used alone in 9 cases and in association with extracorporeal shock wave lithotripsy (ESWL) in 9 cases. ESWL was used alone in 18 cases. Medical treatment included high fluid intake, alkalinisation and Thiola (tiopronin, N-(2-mercaptopropionyl)glycine) in 6 patients. The overall stone-free rate assessed 3 months after treatment was 44.7%, which compares poorly with the rate for non-cystine stones. The recurrence rate is very high and instrumental treatment should not therefore be used excessively; it is indicated only for stones that are symptomatic or refractory to intensive medical therapy.
Martin
X
X
Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard Herriot, Lyon, France.
Salas
M
M
Labeeuw
M
M
Pozet
N
N
Gelet
A
A
Dubernard
J M
JM
D000293:Adolescent; D000328:Adult; D003553:Cystine / Q000032:analysis; D003555:Cystinuria / Q000150:complications*; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014545:Urinary Calculi / Q000737:chemistry / Q000209:etiology / Q000628:therapy*
D003553:Cystine