Dissolution of Cystine Calculi by Pelviocaliceal Irrigation with B-Penicillamine

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Abstract
A cystinuric patient is reported in whom unilateral hydronephrosis developed as a result of massive renal stone formation owing to non-compliance of systemic penicillamine therapy. At operation a large number of calculi could not be removed for technical reasons. After successful in vitro dissolution of 1 calculus using a 0.5% solution of D-penicillamine at pH 8.0, the same solution was used to irrigate the renal collecting system via a nephrostomy tube. After 2 mo. of daily irrigations, which were decreased to 2 times a week for another 2 mo., all the stones appeared radiographically to have disappeared. At followup 2 yr after removal of the nephrostomy tube, the patient is on regular systemic therapy with no evidence of residual or recurrent stone formation.

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