Dissolution of cystine calculi by pelviocaliceal irrigation with D-penicillamine

We report on a cystinuric patient in whom unilateral hydronephrosis developed as a result of massive renal stone formation owing to non-compliance of systemic penicillamine therapy. At operation a large number of calculi could not be removed for technical reasons. After successful in vitro dissolution of 1 calculus using a 0.5 per cent solution of D-penicillamine at pH 8.0 the same solution was used to irrigate the renal collecting system via a nephrostomy tube. After 2 months of daily irrigations, which were decreased to 2 times a week for another 2 months, all the stones appeared radiographically to have disappeared. At followup 2 years after removal of the nephrostomy tube the patient is on regular systemic therapy with no evidence of residual or recurrent stone formation.