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Impact of a metabolic stone clinic on management of patients with cystinuria: 5 years follow-up.
[cystinuria]
Cystinuric
patients
develop
new
stones
and
exhibit
stone
growth
despite
conservative
measures
and
often
require
surgical
intervention
.
There
have
been
reports
of
better
outcome
both
in
surgical
intervention
rates
and
compliance
when
patients
were
referred
to
dedicated
metabolic
stone
clinics
.
We
wish
to
report
our
experience
in
the
running
of
a
metabolic
stone
disease
clinic
and
to
compare
our
intervention
rates
to
the
pre-metabolic
stone
clinic
period
in
our
department
.
We
reviewed
retrospectively
our
cystinuria
patients
'
database
between
the
years
of
1992
and
2008
.
Patients
were
divided
into
two
groups
.
Group
A
patients
(
n
=
28
)
were
treated
before
the
introduction
of
a
dedicated
stone
clinic
(
years
1992
-
2002
)
and
group
B
patients
(
n
=
28
)
after
the
establishment
of
the
metabolic
stone
clinic
but
every
group
B
patient
had
a
minimum
follow
up
of
5
years
.
21
patients
were
common
between
the
two
groups
.
Main
therapy
included
hyperdiuresis
and
alkalization
.
Parameters
recorded
included
the
number
of
clinic
visits
,
whether
the
patients
were
stone
free
or
asymptomatic
at
the
time
of
our
review
and
the
nature
and
frequency
of
surgical
intervention
.
A
total
number
of
145
procedures
were
carried
out
in
group
A
including
89
ESWL
,
27
PCNL
,
24
ureteroscopy
retrograde
lithotripsies
and
5
open
procedures
.
In
group
B
,
a
total
of
54
procedures
were
carried
out
and
included
6
ESWL
,
5
PCNL
and
43
ureteroscopy
laser
lithotripsies
.
The
average
number
of
surgical
interventions
per
patient
per
year
was
0
.
74
and
0
.
34
in
group
A
and
B
respectively
.
The
number
of
clinic
attendances
increased
in
group
B
to
279
from
188
in
group
A
.
Stone
free
rates
were
46
%
for
group
A
and
50
%
for
group
B
patients
but
all
group
B
patients
were
asymptomatic
at
the
time
of
our
review
.
The
introduction
of
a
dedicated
cystinuria
clinic
halved
the
intervention
rate
in
this
complicated
group
of
patients
.
The
majority
of
surgical
procedures
shifted
towards
ureteroscopies
(
both
as
inpatients
and
as
day
case
procedures
)
.
We
believe
that
cystine
stone
patients
should
be
managed
in
a
devoted
metabolic
stone
clinic
.
With
this
approach
,
compliance
is
better
achieved
and
surgical
intervention
is
less
,
resulting
in
better
clinical
outcome
,
and
less
burden
both
for
the
patient
and
the
urological
services
.
