Treatment of Cystinuria with Cystine Kidney or Ureteral Stone Requiring Surgical Intervention
Clinical Scenario
This protocol addresses patients with cystinuria who present with cystine kidney stones or cystine ureteral stones for which surgical intervention is indicated. Larger renal stones greater than 1 cm, pain, infection, hematuria, and stone growth are among the findings that prompt surgical management.
Cystine Kidney Stone
Cystine Ureteral Stone
Surgical Indication
Surgical Approach — Partial Overview
Surgical stone removal is selected based on stone location and size. Available procedural options include ureteroscopy (URS), extracorporeal shock wave lithotripsy (ESWL), and percutaneous nephrolithotomy (PCNL) — with the choice between them depending on stone characteristics …
The full selection algorithm — covering all size thresholds, location-specific sequences, and procedural preferences — is available in the complete protocol.
References
DOI: 10.1016/j.kint.2020.06.035
Larger renal stones >1 cm, pain, infection, hematuria, and stone growth are indications that should prompt surgical intervention.
ESWL, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) are all options for treating cystine stones (Figure 3).
URS is the mainstay of treatment of ureteral stones and renal stones <20 mm in children and adults.
Although PCNL is recommended for renal stones >20 mm, staged ureteroscopic procedures may be offered because patients with cystinuria often have had multiple previous invasive procedures and high recurrence rates, thus demanding the use of the least invasive methods.
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