title: Multimodal treatments of cystine stones: an observational, retrospective single-center analysis of 14 cases.
abstract: OBJECTIVE
  To document the experiences of a single institution in evaluating the clinical courses and treatment outcomes of patients with cystine stones.
  
  
  METHODS
  The clinical data of 14 patients with cystine stones who were treated at our institution from March 1994 to July 2012 were reviewed. These data included age at first visit, gender, family history, body mass index, presence of a single kidney, stone locations, stone burden, routine urinalysis, and culture. In addition, we also analyzed data on surgery, shock wave lithotripsy, medical treatment, stone recurrence or regrowth, and overall treatment success rates.
  
  
  RESULTS
  The mean age of our patients at their first visit was 19.6±5.0 years, and eight patients were males. The median stone burden and mean urine pH before each surgery were 6.5 cm(2) and 6.5±0.9, respectively. Two patients had a family history of cystine stones. Patients underwent surgery an average of 2.7 times. The median interval between surgeries was 27.3 months, and 1 open surgery, 12 percutaneous nephrolithotomies, and 25 ureterorenoscopies were performed. Potassium citrate or sodium bicarbonate was used in nine cases. D-Penicillamine was continuously used in three patients. Patients had an average incidence of 3.2 recurrences or regrowth of stones during the median follow-up period of 60.5 months.
  
  
  CONCLUSIONS
  Patients with cystine stones have high recurrence or regrowth rates and relatively large stone burdens. Adequate treatment schedules must therefore be established in these cases to prevent possible deterioration of renal function.
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Myungsun
authors.initials: M
authors.lastname: Shim
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyung Keun
authors.initials: HK
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D003553:Cystine / Q000032:analysis*; D003555:Cystinuria / Q000150:complications; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007669:Kidney Calculi / Q000737:chemistry / Q000473:pathology / Q000628:therapy; D008096:Lithotripsy / Q000379:methods; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000737:chemistry / Q000473:pathology / Q000628:therapy; D014545:Urinary Calculi / Q000737:chemistry / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D003553:Cystine
keywords: Calculi; Cystinuria; Nephrolithiasis; Urolithiasis