A case of cystine calculus in a two-year-old infant.
A two-year-old boy developed abdominal pain and vomiting at initial onset. After referral to our hospital, diagnostic images disclosed a large urinary calculus in the right pelvis involving hydronephrosis. From the results of urinalysis, a cystine calculus caused by cystinurina was suspected. At first, we considered the possibility of destroying it with extracorporeal shock wave lithotripsy (ESWL) or removing it with endoscopic instruments, but instead selected pyelolithotomy because of the calcular characteristics and the patient's renal dysfunction. The choice of treatment for urinary calculus in a child may depend on the calcular size or component and on the patient's status. The availability of ESWL for the treatment of urinary calculi in pediatric patients has been recognized, but there should be no hesitation in selecting pyelolithotomy in cases presenting with difficulty or complications.