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Renal autotransplantation and modified pyelovesicostomy for intractable metabolic stone disease.
[cystinuria]
Some
patients
with
intractable
metabolic
stone
disease
experience
narcotic
dependence
,
which
can
not
be
managed
with
standard
treatments
.
We
offered
these
patients
renal
autotransplantation
with
a
modified
pyelovesicostomy
as
an
alternative
solution
.
Renal
autotransplantation
with
pyelovesicostomy
was
performed
for
15
kidneys
in
12
patients
(
3
bilateral
,
2
solitary
)
,
9
female
and
3
male
,
with
a
mean
age
of
33
.
8
years
(
range
16
to
55
)
.
The
etiology
of
metabolic
stone
disease
was
calcium
oxalate
(
40
%
)
,
cystinuria
(
33
%
)
,
type
1
renal
tubular
acidosis
(
14
%
)
,
calcium
oxalate
/
urate
(
7
%
)
and
medullary
sponge
kidney
(
7
%
)
.
Patients
reported
that
lifetime
stone
events
ranged
from
10
to
more
than
70
,
that
underwent
an
average
of
3
to
4
surgical
interventions
per
year
in
the
previous
2
years
and
that
they
were
dependent
on
daily
oral
narcotics
for
stone
related
pain
.
All
15
kidneys
were
successfully
autotransplanted
with
a
mean
followup
of
41
.
8
months
(
range
3
to
74
)
.
We
used
a
modified
pyelovesicostomy
with
ureteral
strip
in
13
and
standard
Boari
tube
in
2
cases
.
All
patients
continued
to
pass
small
stone
debris
per
urethra
with
minimal
symptoms
.
Of
12
patients
11
(
92
%
)
were
weaned
off
daily
narcotics
.
There
have
been
17
stone
episodes
in
4
patients
(
3
cystinuria
)
for
which
medical
intervention
and
pain
medication
was
required
.
The
number
of
urological
procedures
/
patients
before
(
155
/
12
[
12
.
9
]
)
and
after
(
8
/
12
[
0
.
66
]
)
autotransplantation
was
dramatically
reduced
(
paired
t
test
p
=
0
.
0001
)
.
The
preoperative
mean
estimated
glomerular
filtration
rate
was
77
.
2
cc
/
minute
,
and
73
.
5
,
71
.
9
,
79
.
2
cc
/
minute
at
12
,
36
and
60
months
,
respectively
.
Renal
autotransplantation
and
pyelovesicostomy
offer
patients
with
intractable
metabolic
stone
disease
the
opportunity
to
improve
quality
of
life
and
to
decrease
daily
narcotic
use
.
Diseases
Validation
Diseases presenting
"modified pyelovesicostomy with ureteral strip"
symptom
cystinuria
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