Percutaneous nephrolithotripsy (PNL) is performed via a port created by puncturing the kidney through the skin and enlarging the access port to 1 cm in diameter. Most of the time, cystine stones are too dense to be broken up by shock (ESWL) so PNL is needed.Videos of surgery are available on various websites that show stone removal by percutaneous nephrolithotomy.In February 2017, an article was published in Nature Medicine entitled "Alpha lipoic acid treatment prevents cystine urolithiasis in a mouse model of cystinuria", suggesting that a high dose of the readily available antioxidant, alpha-lipoic acid at 2,700 mg/67 kg body weight daily reduced the incidence of stones. The effects were dose dependent. The results are unprecedented for cystinuria. A clinical trial is underway based on this mouse model. Occurrence in animals
This disease is known to occur in at least four mammalian species: humans, domestic canines, domestic ferrets and a wild canid, the maned wolf of South America. Cystine uroliths have been demonstrated, usually in male dogs, from approximately 70 breeds including the Australian cattle dog, Australian shepherd, Basenji, Basset, Bullmastiff, Chihuahua, Scottish deerhound, Scottish terrier, Staffordshire terrier, Welsh corgi, and both male and female Newfoundland dogs. See also
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Brazil
The Brazilian vehicle fleet reached 64.8 million vehicles in 2010, up from 29.5 million units in 2000, representing a 119% growth in ten years, and reaching a motorization rate of 340 vehicles per 1000 people. In 2010 Brazil experienced the second largest fleet increase in the world after China, with 2.5 million vehicle registrations.As of 2018, Brazil has the largest alternative fuel vehicle fleet in the world with about 40 million alternative fuel motor vehicles in the road. The clean vehicle stock includes 30.5 million flexible-fuel cars and light utility vehicles and over 6 million flex-fuel motorcycles by March 2018; between 2.4 and 3.0 million neat ethanol vehicles still in use, out of 5.7 million ethanol only light-vehicles produced since 1979; and, as of December 2012, a total of 1.69 million natural gas vehicles.In addition, all the Brazilian gasoline-powered fleet is designed to operate with high ethanol blends, up to 25% ethanol fuel (E25). The market share of flex fuel vehicles reached 88.6% of all light-duty vehicles registered in 2017. India
Indias vehicle fleet had the second-largest growth rate after China in 2010, with 8.9%. The fleet went from 19.1 million in 2009 to 20.8 million units in 2010. Indias vehicle fleet has increased to 210 million in March 2015. India has a fleet of 1.1 million natural gas vehicles 
as of December 2011 .