Hughes T. et al., 2023: Cystine Stones: Developments in Minimally Invasive Surgery and Their Impact on Morbidity and Stone Clearance.
Department of Urology, Warwick Hospital, Warwick, UK.
Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Department of Urology, University Hospital Southampton, Southampton, UK.
Abstract
Cystinuria is a rare genetic condition that is responsible for cystine stones. Besides stone recurrence, patients with cystine stones have reduced health-related quality of life, increased rates of chronic kidney disease and hypertension. Although lifestyle measures, medical therapy and close follow up are essential to reduce and monitor cystine stone recurrences, surgical intervention is frequently needed for most cystinuria patients. Shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and active surveillance all have a role, and technological advances in endourology are vital in achieving a stone-free status and to prevent recurrences. The complexity of managing cystine stones necessitates a multidisciplinary team discussion, patient involvement and an individualised approach in a specialist centre for optimum management. Thulium fibre laser and virtual reality may have an increasing role in the future of cystine stone management.
1. Thomas K, et al. Cystinuria – a urologist’s perspective. Nat Rev Urol. (2014) 11:270–7. doi: 10.1038/nrurol.2014.51
2. Warren H, et al. Non-contrast computed tomography characteristics in a large cohort of cystinuria patients. World J Urol. 2021 Jul;39(7):2753-2757. doi: 10.1007/s00345-020-03509-0. Epub 2020 Nov 9. PMID: 33169184; PMCID: PMC8332560.
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Comments 1
There is only a short paragraph on SWL with no new information. The fact that cystine stones may differ in their crystalline structures and that this might be apparent in the radiological examinations is by now probably known by most urologists: the loosely packed rough (cystine-R) stones respond better to SWL than the densely packed smooth (cystine- S) stones. However, literature data concerning identification by CT are conflicting (1,2) and may depend on the imaging technique used.
In the short section on diagnostic aspects a simple advice on stone analysis was missing: the easiest, reliable and cheapest way of stone analysis is to put a flame to the stone: this causes a unique, typical sulfur smell.
Peter Alken