A male presented to the emergency depament with renal calculi. Extracorporeal shock wave lithotripsy was suggested after a detailed examination. But the procedure failed. Which of the following type of stone is MOST resistant to lithotripsy?
Cystine lithiasis: Cystine lithiasis is secondary to an inborn error of metabolism resulting in abnormal intestinal (small bowel) mucosal absorption and renal tubular absorption of dibasic amino acids, including cystine, ornithine, lysine, and arginine. The solubility of cystine is pH-dependent, with a pK of approximately 8.1. There is no known inhibitor for cystine calculi, and cystine stone formation is completely dependent on excessive cystine excretion. Radiographic appearance of a faintly opaque, ground-glass, smooth-edged stone. Surgical treatment is similar to that for other stones except that most stones are recalcitrant to extracorporeal shock wave lithotripsy (ESWL). Ref: Stoller M.L. (2008). Chapter 16. Urinary Stone Disease. In E.A. Tanagho, J.W. McAninch (Eds), Smith's General Urology, 17e.
Ca oxalate
Triple phosphate
Uric acid
Cystine