Treatment of cystine urolithiasis by a combination of extracorporeal shock wave lithotripsy and chemolysis.

Minimally invasive surgical procedures are particularly desirable in patients with cystine stones because of their often multiple previous operations, complicated stone situations, and high risk of recurrences. Twenty-four treatment episodes for cystine stones were carried out, 12 with extracorporeal shock wave lithotripsy (ESWL) as monotherapy and 12 with a combination of ESWL and percutaneous irrigation with chemolytic solutions. In the ESWL monotherapy group, five of 12 renal units became stone-free and one more patient was discharged stone-free, except for an untreated stone in a calix diverticulum. Combined treatment, most often given in association with more complicated stone situations, rendered seven out of 12 kidneys stone-free. Even in this group, one patient was discharged with an untreated residual stone in a calix diverticulum. Our results show that even complicated cystine stone situations can be successfully treated in a minimally invasive way, with the best results obtained with a combination of ESWL and percutaneous chemolysis. Alkalization of urine seemed to be insufficient in preventing stone formation. No difference in recurrence rate was observed between our two treatment groups.