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Cystine Stones: The Impact of New Treatment
Author(s) -
MARTIN X.,
SALAS M.,
LABEEUW M.,
POZET N.,
GELET A.,
DUBERNARD J. M.
Publication year - 1991
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1991.tb15313.x
Subject(s) - tiopronin , cystinuria , medicine , extracorporeal shock wave lithotripsy , cystine , refractory (planetary science) , surgery , fluid intake , lithotripsy , urology , biochemistry , chemistry , physics , cysteine , astrobiology , enzyme
Summary The hardness and frequent recurrence of cystine stones present a special challenge to the urologist. In this study, 15 cystinuric patients (11 males, 4 females; mean age 36 years, range 17–54) were treated and followed up over a period of 30 months (range 2–40). Most patients had a previous history of open surgery. The diagnosis of cystinuria was confirmed by metabolic studies and infrared spectrometry of stones. Over the follow‐up period recurrence was observed in 23 instances in 11 patients, leading to 38 “stone treatments” on 74 cystine stones. The percutaneous approach was used alone in 9 cases and in association with extracorporeal shock wave lithotripsy (ESWL) in 9 cases. ESWL was used alone in 18 cases. Medical treatment included high fluid intake, alkalinisation and Thiola (tiopronin, N‐(2‐mercaptopropionyl)glycine) in 6 patients. The overall stone‐free rate assessed 3 months after treatment was 44.7%, which compares poorly with the rate for non‐cystine stones. The recurrence rate is very high and instrumental treatment should not therefore be used excessively; it is indicated only for stones that are symptomatic or refractory to intensive medical therapy.