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Shim M et al, 2014: Multimodal treatments of cystine stones: an observational, retrospective single-center analysis of 14 cases.

Shim M, Park HK

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

 

 

Abstract

PURPOSE: To document the experiences of a single institution in evaluating the clinical courses and treatment outcomes of patients with cystine stones. MATERIALS AND 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.

Korean J Urol. 2014 Aug;55(8):515-9. doi: 10.4111/kju.2014.55.8.515. Epub 2014 Aug 8.

 

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Comments 1

Hans-Göran Tiselius on Monday, 03 November 2014 07:57

This article is just a description of the authors’ experience of management of 14 patients with cystinuria and cystine stone formation. Although SWL is mentioned in the text and apparently used in 8 patients the results of this technique are not further discussed. The reason appears to be that the authors make a distinction between surgical (endoscopic and open) procedures and SWL. It is my own experience that SWL is underused in the treatment of cystine stone patients. The SWL resistance is most certainly the reason for that, but the results with SWL are not at all bad, particularly for relatively small stones and for those with a less compact morphology. For cystine stone patients who need frequently repeated stone removing procedures, the non-invasive option is indeed a valuable tool.

This article is just a description of the authors’ experience of management of 14 patients with cystinuria and cystine stone formation. Although SWL is mentioned in the text and apparently used in 8 patients the results of this technique are not further discussed. The reason appears to be that the authors make a distinction between surgical (endoscopic and open) procedures and SWL. It is my own experience that SWL is underused in the treatment of cystine stone patients. The SWL resistance is most certainly the reason for that, but the results with SWL are not at all bad, particularly for relatively small stones and for those with a less compact morphology. For cystine stone patients who need frequently repeated stone removing procedures, the non-invasive option is indeed a valuable tool.
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