Retrograde transureteral approach: a safe and efficient treatment for recurrent cystine renal stones

Abstract

Most patients presenting cystinuria require multiple urological procedures during their lifetime. In this kind of patients the availability of minimally invasive procedure represents an advantage of minimizing the cumulative morbidity of several repeated treatments. Herein we report our experience using ureterorenoscopy (URS) for the treatment of recurrent renal cystine stones. From 2003 to 2007, 10 patients (4 males and 6 females) with one or multiple recurrent renal cystine stones underwent URS. Overall, 21 procedures have been performed. Mean maximum diameter of stones was 11.2 mm (range 5-30 mm). Either 8-9.5 F semirigid or 7.9 F flexible ureteroscopes were used. In 6 cases, stones were removed using a basket; in 9 procedures laser lithotripsy with flexible scope was performed; in 6 cases renal calculi were pulled down in the ureter using flexible instrument and then shattered with laser introduced by semirigid instrument. Stone-free status was defined as the absence of any residual fragment. A complete stone clearance was obtained in 15 out of 21 procedures (71%). In 5 cases (24%) significant residual fragments occurred; in the remaining case (5%) URS was ineffective. In 5 out of these unsuccessful procedures, stone clearance was obtained with auxiliary treatments. The last patient has not been treated yet. No major complications occurred as a result of the procedures. URS offers excellent advantages in case of recurrent hard calculi such as cystine stones. Minimally invasive procedures allow satisfactory outcomes, improving patients' quality of life.

Multimodal Treatments of Cystine Stones: An Observational, Retrospective Single-Center Analysis of 14 Cases

“…Another previous study reported a success rate of 71% in patients with cystine stones who underwent URS [15]. Although there are some differences in the definition of treatment success, the success rate among our current patient series (64.3%) is comparable with previous results.…”

“…One previous study reported a complication rate associated with PCNL in patients with cystine stones of 15.4% [14]. Another study reported an overall complication rate of 23.8% for URS [15]. The complication rate we observed in the present series was 11.4%, but none of these complications were major and thus no additional procedures were needed to manage them.…”

The Impact of Body Mass Index on the Outcomes of Retrograde Intrarenal Stone Surgery

“…It is well known that patients with cystine calculi have high stone recurrence rates. 26 Because these patients may require repeated surgical procedures during their lifetime, they have to be treated with minimal invasive techniques. Ruggera et al 26 have reported an SFR of 71% after ureteroscopic procedures for patients with cystine renal stones.…”

“…26 Because these patients may require repeated surgical procedures during their lifetime, they have to be treated with minimal invasive techniques. Ruggera et al 26 have reported an SFR of 71% after ureteroscopic procedures for patients with cystine renal stones. Similarly, in our study group, we achieved a stonefree status in 8 patients (72.7%) without any major complication.…”

Cystinuria—a urologist's perspective

“…75 Ureterorenoscopy Rigid ureteroscopy or flexible ureterorenoscopy (also known as retrograde intrarenal surgery) is a suitable treatment modality for the majority of ureteric and pelvi calyceal stones (<2 cm). 38,76 Ureteroscopic surgery is mini mally invasive and confers low morbidity with a short hospital stay, a major advantage over other techniques, such as percutaneous nephrolithotomy (PCNL) and open surgery, and is of particular importance for patients with cystinuria, who often undergo multiple procedures, pos sibly in the context of having established CKD or a single kidney. The holmium laser can fragment even the hardest stone and is the ideal energy source for ureteroscopic surgery.…”