[Treatment of cystine calculi using intra-urologic methods and extracorporeal lithotripsy].
The hardness and frequent recurrence of cystine stones represent a special challenge for the urologist. Fifteen cystinuric patients were treated in our department and followed over a mean period of 30 months. Most patients had a previous history of open surgery (1.5 pyelolithotomy/patient). Diagnosis of cystinuria was confirmed by metabolic studies and stone analysis. Over the follow-up period recurrence was observed in 23 instances in 11 patients thus leading to 38 stone treatments on 74 cystine stones. Stone size was less than 10 mm: 35 (47%); 10-20 mm: 21 (28%); 20-30 mm: 14 (19%); 30 mm: 4 (staghorn stones). A percutaneous approach was used in 9 cases as monotherapy (55% success) and in association with ESWL in 10 cases (50% success). ESWL was employed 18 times as monotherapy (39% success). Medical treatment included high fluid intake, alkalinisation and thiola in 6 patients. In conclusion, results obtained are poor in terms of stone clearance when compared to non-cystine stones. Recurrence rate is very high. Instrumental treatment should not be used excessively and is only indicated in symptomatic stones or refractory to intensive medical therapy.
Martin
X
X
Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard-Herriot, Lyon.
Salas
M
M
Labeeuw
M
M
Pozet
N
N
Gelet
A
A
Dubernard
J M
JM
D000293:Adolescent; D000328:Adult; D000468:Alkalies / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003553:Cystine / Q000032:analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008096:Lithotripsy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000706:statistics & numerical data; D012008:Recurrence
D000468:Alkalies; D003553:Cystine