Mp04-09 Ureteroscopic Management in Cystinuric Patients: Long-Term Results From a Tertiary Care Referral Center

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) I (MP04)1 May 2024MP04-09 URETEROSCOPIC MANAGEMENT IN CYSTINURIC PATIENTS: LONG-TERM RESULTS FROM A TERTIARY CARE REFERRAL CENTER Luigi Candela, Catalina Solano, Marie Chicaud, Eugenio Ventimiglia, Stessy Kutchukian, Mariela Corrales, Luca Villa, Francesco Montorsi, Andrea Salonia, Frederic Panthier, Steeve Doizi, Emmanuel Letavernier, Jean Philippe Haymann, Michel Daudon, and Olivier Traxer Luigi CandelaLuigi Candela , Catalina SolanoCatalina Solano , Marie ChicaudMarie Chicaud , Eugenio VentimigliaEugenio Ventimiglia , Stessy KutchukianStessy Kutchukian , Mariela CorralesMariela Corrales , Luca VillaLuca Villa , Francesco MontorsiFrancesco Montorsi , Andrea SaloniaAndrea Salonia , Frederic PanthierFrederic Panthier , Steeve DoiziSteeve Doizi , Emmanuel LetavernierEmmanuel Letavernier , Jean Philippe HaymannJean Philippe Haymann , Michel DaudonMichel Daudon , and Olivier TraxerOlivier Traxer View All Author Informationhttps://doi.org/10.1097/01.JU.0001008708.00982.a9.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystine stone formers are at higher risk of developing early Chronic Kidney Disease (CKD) compared to other urinary stone formers. To improve renal prognosis, non-invasive urological interventions should be preferred to manage stone recurrences. We sought to evaluate long-term surgical outcomes and renal function modification of cystinuric patients exclusively treated with retrograde Ureteroscopy (URS). METHODS: Data from patients endoscopically treated for cystine stones from 2008 to 2021 at a single academic referral center were retrospectively analyzed. The ureteroscopic management protocol consisted of i) treating patients with symptomatic or>7 mm stones, ii) multiple staged URS for voluminous stones, iii) referring patients to a dedicated nephrological clinic. Stone-free was defined as the absence of any fragment at postoperative CT scan. The estimated Glomerular Filtration Rate (eGFR) was calculated using the first and the last available serum creatinine level according to the Modification of Diet in Renal Disease (MDRD) formula. Chronic Kidney Disease stage was assessed according to the National Kidney Foundation classification. Severe CKD was defined as CKD category ≥3a (i.e. eGFR<60 ml/min /1.73 m2). Descriptive statistics were used to analyze the cohort data. RESULTS: Data from 46 cystinuric patients treated with a total of 332 URS and laser lithotripsy were available. Median (IQR) age at diagnosis and at first URS in our center were 18 (10-26) and 32 (22-46) years, respectively. Median (IQR) follow-up was 101 (70—146) months. The median (IQR) number of URS and recurrences during FU were 6 (3.75-10.25) and 2 (1-4), respectively. At the end of follow-up, 24 (52%) patients were stone-free. The median (IQR) interval between the first and the last available creatinine level was 64 (45-78) months. Median (IQR) first and last eGFR were 72 (57-97.5) and 74 (66-88) mL/min, respectively. Overall, 83% of patients had stable or improved renal function within the study period. However, 17% of patients developed new-onset CKD of any grade. Figure 1 depicts the percentages of patients according to the CKD category at the beginning and at the end of the follow-up. Ureteral stricture occurred in 3 (6.5%) patients. CONCLUSIONS: Cystinuria requires intensive endoscopic management. Most patients treated conservatively with URS in a referral center have stable or improved renal function within a long-term follow-up. However, CKD and ureteral strictures are not neglectable events that potentially occur at an early stage of life. Current findings should be considered for the surgical management of cystinuric patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e37 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Luigi Candela More articles by this author Catalina Solano More articles by this author Marie Chicaud More articles by this author Eugenio Ventimiglia More articles by this author Stessy Kutchukian More articles by this author Mariela Corrales More articles by this author Luca Villa More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Frederic Panthier More articles by this author Steeve Doizi More articles by this author Emmanuel Letavernier More articles by this author Jean Philippe Haymann More articles by this author Michel Daudon More articles by this author Olivier Traxer More articles by this author Expand All Advertisement PDF downloadLoading ...