Ureteroscopic Management of Recurrent Renal Cystine Calculi
Kourambas J, Delvecchio F, Kuo R, Preminger G

INTRODUCTION: Patients with recurrent cystine nephrolithiasis oftentimes require multiple procedures for stone removal. As the majority of cystine stones are resistant to shock wave lithotripsy, repeat percutaneous surgery can cause renal damage. Moreover, repeat percutaneous access may become more difficult as perinephric fibrosis develops. Small caliber ureteroscopes along with the holmium laser now enable routine intrarenal ureteroscopic access to symptomatic renal stones. Herein we present our experience in managing recurrent renal cystine calculi in select patients with a ureteroscopic approach.

MATERIALS: Over the past twelve months, we have managed large volume renal cystine nephrolithiasis via a ureteroscopic approach in 3 patients. A 7.5 French flexible ureterorenoscope combined with holmium laser lithotripsy was utilized to completely fragment stones averaging 2.2 cm in diameter.

RESULTS: The mean treatment time was 97 minutes, with successful fragmentation in all cases. Two of the three patients were completely stone free on follow up intravenous pyelography with the third patient having only small volume residual fragments in the lower pole calyx. All patients are currently asymptomatic and are being maintained on high fluid intake, urinary alkalization with potassium citrate and Thiola to lower urinary cystine excretion.

CONCLUSIONS: Flexible ureteroscopy with holmium laser lithotripsy provides a reasonable alternative for the management for recurrent cystine calculi in patients who are not candidates for repeat percutaneous procedures. Although time consuming, complete stone fragmentation along with clearance of fragments can be achieved in the majority of patients.

Journal of Endourology, Vol. 13 Supplement 1, A122 Sep 1999

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