Percutaneous catheter dissolution of cystine calculi.
In 11 kidneys with presumed cystine stones that were symptomatic and obstructing, percutaneous nephrostomy and stone lavage with either acetylcysteine-bicarbonate solution or tromethamine-E were performed. There were 7 complete stone dissolutions: 2 of 6 attempts with acetylcysteine-bicarbonate alone, 3 of 5 with tromethamine-E, 1 partial with acetylcysteine-bicarbonate, which was completed with tromethamine-E, and 1 proved mixed stone (cystine and calcium phosphate) that required acetylcysteine-bicarbonate and hemiacidrin. In 1 case tromethamine-E irrigation was 97 per cent complete but a few tiny caliceal fragments remained. There were 3 failures of chemolysis: 2 pure cystine stones (1 each acetylcysteine-bicarbonate and tromethamine-E) and 1 mixed calculus with a surface shell of calcium oxalate. Irrigation time was 6 to 42 days for the 7 unoperated kidneys. Tromethamine-E appears to be a more effective agent for cystine stone dissolution. Percutaneous nephrostomy and dissolution are an alternative to an operation in patients with cystine calculous disease.
D000111:Acetylcysteine / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D001639:Bicarbonates / Q000627:therapeutic use; D002404:Catheterization / Q000379:methods*; D002951:Citrates / Q000627:therapeutic use; D003553:Cystine; D003555:Cystinuria / Q000601:surgery; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011677:Punctures; D007507:Therapeutic Irrigation; D013997:Time Factors; D014325:Tromethamine / Q000627:therapeutic use; D014567:Urography
D001639:Bicarbonates; D002951:Citrates; C026485:hemiacidrin; D014325:Tromethamine; D003553:Cystine; D000111:Acetylcysteine