Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Cleveland Clinic, Cleveland, Ohio.
J Urol. 2018 Dec;200(6):1285-1289. doi: 10.1016/j.juro.2018.07.047. Epub 2018 Jul 27.
Patients with cystinuria are often treated with medical alkalization and shock wave lithotripsy, although each treatment is hypothesized to increase the risk of calcium phosphate stones. We performed a multicenter retrospective review to evaluate whether stones of another composition develop in patients with cystinuria and with what frequency.
We retrospectively reviewed the records of a multi-institutional cohort of patients with cystinuria. We assessed medications, stone analyses, 24-hour urinalyses and types of procedures. We compared patients who formed only cystine stones vs those with noncystine stones.
We identified 125 patients from a total of 5 institutions who were followed a mean of 5.2 years (range 0 to 26). Stones with noncystine components were submitted by 37 patients (29.6%). Potassium citrate medication was not associated with a noncystine composition (p = 0.1877). Regarding surgical management 18 patients (13%) underwent at least 1 shock wave lithotripsy session (range 0 to 9) and 79 (63%) underwent percutaneous nephrolithotomy at least once (range 0 to 10). When stratified based on pure cystine vs converted stones, the average total number of shock wave lithotripsy and percutaneous nephrolithotomy procedures was higher in the group with cystine and subsequent noncystine stone compositions (0.94 vs 0.10, p <0.0001, and 1.7 vs 1.5, p = 0.0053, respectively). On logistic regression male gender (OR 3.1, p = 0.0280) and the number of shock wave lithotripsy sessions (OR 3.0, p = 0.0170) were associated with an increased likelihood of the development of stones with a noncystine composition.
Stones with noncystine components develop in more than 25% of patients with cystinuria, underscoring the importance of continued stone analysis. In this study prior shock wave lithotripsy was associated with conversion to a noncystine stone composition while urinary alkalization therapy was not associated.
胱氨酸尿症患者常接受医学碱化和冲击波碎石术治疗，尽管每种治疗方法都被假设会增加磷酸钙结石的风险。我们进行了一项多中心回顾性研究，以评估胱氨酸尿症患者是否会形成另一种成分的结石，以及其发生的频率。
我们回顾性分析了来自多家机构的胱氨酸尿症患者队列的记录。我们评估了药物、结石分析、24 小时尿液分析和手术类型。我们比较了仅形成胱氨酸结石的患者和形成非胱氨酸结石的患者。
我们从 5 家机构中总共确定了 125 名患者，他们的平均随访时间为 5.2 年（范围 0 至 26 年）。37 名患者（29.6%）提供了含有非胱氨酸成分的结石。枸橼酸钾药物与非胱氨酸成分无关（p=0.1877）。在手术管理方面，18 名患者（13%）至少进行了 1 次冲击波碎石术（范围 0 至 9 次），79 名患者（63%）至少进行了 1 次经皮肾镜取石术（范围 0 至 10 次）。根据纯胱氨酸与转化结石进行分层，胱氨酸和随后的非胱氨酸结石成分组的冲击波碎石术和经皮肾镜取石术的平均总次数更高（0.94 与 0.10，p<0.0001 和 1.7 与 1.5，p=0.0053）。在逻辑回归中，男性（OR 3.1，p=0.0280）和冲击波碎石术次数（OR 3.0，p=0.0170）与非胱氨酸结石成分形成的可能性增加相关。
超过 25%的胱氨酸尿症患者会形成含有非胱氨酸成分的结石，这强调了持续进行结石分析的重要性。在这项研究中，先前的冲击波碎石术与转化为非胱氨酸结石成分相关，而尿液碱化治疗则无相关性。
