Results of Non-Surgical Treatment of Uric Acid and Cystine Calculi
Of 1,650 patients who underwent extracorporeal shock wave lithotripsy (ESWL) treatment for renal calculi at UCLA between March 1985 and October 1987, 48 patients (2.97%) had symptomatic uric acid stones and ten patients (0.61%) suffered from symptoms of cystine calculi. Treatment consisted of ESWL combined with urinary alkalinization. Prior to ESWL, radiolucent stones were focused as filling defects on retrograde pyelography. In some cases additional renal ultrasound was necessary to identify the stone-bearing calices. At the three-month follow-up, 34 of 48 (70.8%) patients treated for uric acid stones were stone free; at six months, 40 of 48 (83.3%) patients. In the cystine group five of ten (50%) were stone free after six months. Thirty-six of 48 uric acid stone patients and all cystine stone patients required auxiliary procedures such as placement of percutaneous nephrostomy tubes or double-J stents. Two of the cystine stone patients underwent secondary percutaneous stone surgery to remove larger residual stones for a final stone-free rate of 87.5%. The guidelines for treatment of uric acid and cystine lithiasis in the upper urinary tract are described.
KeywordsUric Acid Shock Wave Lithotripsy Extracorporeal Shock Wave Lithotripsy Ureteral Calculus Uric Acid Stone
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- Chaussy CG and Fuchs GJ: Extracorporeal shock wave lithotripsy. In Stamey TA (ed): Monographs in Urology Vol. 8, No. 4, 1987.Google Scholar
- Chernesky CE, Rodman JS, Reckler J, et al: Urothelial injury to the rabbit bladder from alkaline irrigants useful in the treatment of uric acid stones. J Urol 138: 393, 1987.Google Scholar
- Pahira JJ: Management of the patient with cystinuria. Urol Clin N Am 14: 339, 1987.Google Scholar
- Saltzmann N and Gittes RF: Chemolysis of cystine calculi. J Urol 136: 846, 1986.Google Scholar
- Schmeller N, Kersting H, Schuller J, et al: Combination of chemolysis and shock wave lithotripsy in the treatment of cystine renal calculi. J Urol, 1984.Google Scholar
- Thomas J, Thomas E, Taboury JA, et al: Cystine calculi: in vitro solubility and chemical structure. Ann Urol 21: 37, 1987.Google Scholar