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[Treatment of cystine calculi using intra-urologic methods and extracorporeal lithotripsy]
1Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard-Herriot, Lyon.
Insights
Cystine stones are hard to treat and frequently return, posing challenges for urologists. Treatment success for these stones is poor, with a high recurrence rate necessitating careful consideration of interventions.
Area of Science:
- Urology
- Nephrology
- Metabolic disorders
Context:
- Cystine stones present unique challenges due to their hardness and high recurrence rates.
- Previous surgical interventions like pyelolithotomy were common in the patient cohort.
- Diagnosis was confirmed through metabolic studies and stone analysis.
Purpose:
- To evaluate the effectiveness of various treatment modalities for cystine urolithiasis.
- To assess the recurrence rates and treatment outcomes in patients with cystine stones.
Summary:
- Fifteen cystinuric patients were followed for a mean of 30 months, experiencing 23 recurrences across 11 patients.
- Percutaneous nephrolithotomy (PCNL) showed 55% success as monotherapy and 50% with extracorporeal shock wave lithotripsy (ESWL).
- ESWL monotherapy had a 39% success rate, while medical management (hydration, alkalinization, thiola) was used in 6 patients.
Impact:
- Treatment outcomes for cystine stones are generally poor compared to other stone types.
- The high recurrence rate underscores the need for effective long-term management strategies.
- Instrumental treatments should be judiciously applied, reserved for symptomatic or medically refractory cases.
Abstract:
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.