Experience with Extracorporeal Shock Wave Lithotripsy for Cystine Calculi in 20 Renal Units
AbstractFourteen patients (20 renal units) with cystine stones were treated by extracorporeal shock wave lithotripsy (SWL, Dornier HM3). The cases consisted of four ureteral stones, two renal + ureteral stones, seven renal stones, and seven staghorn calculi. All renal units with ureteral and renal + ureteral stones became stone free at 3 months after the first treatment with an average of 1.5 sessions of SWL without any auxiliary procedure. Six of seven units with renal stones became stone free with an average of 2.1 sessions of SWL. Two of these seven patients required ureteroscopic removal of stone fragments for Steinstrasse. Four of seven renal units with staghorn calculi became stone free with an average of 5.4 sessions of SWL, and all patients required some auxiliary procedures. There were no serious complications. Although cystine calculi are less fragile than stones of other composition, SWL monotherapy is effective and safe for cystine stones 30 mm or smaller. For a relatively large stone or staghorn calculus, the combination of SWL and endourologic procedures is effective and safe.