Management of Cystinuric Patients: An Observational, Retrospective, Single-Centre AnalysisAhmed K. · Khan M.S. · Thomas K. · Challacombe B. · Bultitude M. · Glass J. · Tiptaft R. · Dasgupta P.
Department of Urology, Guy’s and St. Thomas’ NHS Trust, GKT School of Medicine, London, UK
Objective: A critical appraisal of the management of patients with cystine stones treated in our unit in the past 6 years and to analyze the outcome of multimodality therapies. Study Design: An observational, single-centre retrospective study. Methods: We reviewed the records of all patients with stones referred to our centre over a 6-year period from 1998 to 2005. Data recorded included demographic details, medical therapies received/prescribed, compliance with medical therapies, mode of treatment, stone clearance and any recurrence during this period of study. Results: A total of 30 cystinuric patients were treated in our institution over the period of 6 years from 1998 to early 2005. Of these 16 were males and 14 females with an average age at last follow-up of 39 years (range 15–70). Two patients were successfully managed medically. The remaining patients (n = 28) underwent a total of 237 procedures (pre- and postreferral to our unit), with an average of 7.9 procedures per patient for 126 stone episodes (4.2 episodes/patient). The modes of treatment included extracorporeal shockwave lithotripsy (n = 143), ureterorenoscopy and intracorporeal lithotripsy (n = 50), percutaneous nephrolithotomy (n = 28) and open procedures (n = 16). Two patients needed open surgery at our unit. Prior to referral to our dedicated unit, patients had received treatment with extracorporeal shockwave lithotripsy (multiple sessions), ureteroscopy (n = 14), percutaneous nephrolithotomy (n = 4) and open stone removal (n = 14). Most of the stones at our unit were managed using minimally invasive therapies. Conclusion: Compliance of cystinuric patients with medical treatment is often poor and patients experience recurrent stone episodes requiring multiple interventions. Modern management of cystine calculi should be with staged minimally invasive procedures to avoid the complications of multiple open procedures wherever possible along with appropriate medical prophylaxis.
© 2008 S. Karger AG, Basel
Dr. Kamran Ahmed
Senior House Officer, Department of Urology
London SE1 9RT (UK)
Tel. +44 79 3931 9670, Fax +44 20 7188 6787, E-Mail firstname.lastname@example.org
Poster Presentation: World Congress of Endourology, Amsterdam, Netherlands, August 2005.
Received: August 14, 2006
Accepted after revision: April 27, 2007
Published online: March 19, 2008
Number of Print Pages : 4
Number of Figures : 1, Number of Tables : 2, Number of References : 11
Vol. 80, No. 2, Year 2008 (Cover Date: March 2008)
Journal Editor: Wirth M.P. (Dresden), Porena M. (Perugia), Hakenberg O.W. (Rostock), Castro-Diaz D. (Santa Cruz de Tenerife)
ISSN: 0042–1138 (Print), eISSN: 1423–0399 (Online)
For additional information: http://www.karger.com/UIN