超音波碎石機處理胱胺酸尿相關之高蛋白質腎結石
郭謹瑋、林介山
彰化基督教醫院 外科部 泌尿科
Ultrasonic Lithotripter to Eliminate Cystinuria Related Protein-rich Renal Stone
Chin-Wei Kuo, Jensen Lin
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Introduction
Cystinuria is an inherited autosomal recessive disease that is characterized by the formation of cystine stones in the kidneys, ureter, and bladder. The roles of treatment include eliminate stone, increase solubility and decrease concentration of cysteine. However, recurrent urolithiasis is common problem in this kind of patients. We demonstrate one cystinuria patient who suffered from persistent protein-rich renal stone with pyelonephritis. And the stone was eliminated via ultrasonic lithotripter.
Case
A 13 y/o female, who was diagnosed as cysinuria with bilateral renal stone in 2013. We arranged PCNL accompanied with ESWL and URSL for stone removal. However, in 2015, recurrent APN was noted. The URS revealed massive soft, elastic and white stone in bilateral kidney. We use lithoclast to disintegrate the stone first, but the result is not satisfied due to soft stone and migrates easily. And recurrent APN with hydronephrosis were noted. Finally, we tried URS with ultrasonic lithotripter to remove the stone. The marvelous result was noted with nearly total removal of stone (with VIDEO). And she was discharged uneventfully. The post OP follow up showed no hydoronephrosis or any pyelonephritis sign.
Discussion
Cystinuria is a rare inherited autosomal recessive disease. Recurrent urolithiasis is a big problem in this kind of patients. In our case, the recurrent stone composition showed protein rich calcium with soft and elastic morphology. It is hard to use lithoclast to disintegrate it and residual stone will cause recurrent hydronephrosis and APN. The ultrasonic lithotripter connected with suction bottle can suck the stone toward the probe. And the soft component is easy to remove via this device. On the other hand, we can remove turbid urine via irrigate with lots normal saline with persistent suction. And the result is satisfied.
Conclusion:
Ultrasonic lithotripter is a good device to remove soft, elastic, protein rich renal stone caused by cystinuria.