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2013 ; 95
(7
): 523-8
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Recurrent urolithiasis following parathyroidectomy for primary
hyperparathyroidism
#MMPMID24112502
Rowlands C
; Zyada A
; Zouwail S
; Joshi H
; Stechman MJ
; Scott-Coombes DM
Ann R Coll Surg Engl
2013[Oct]; 95
(7
): 523-8
PMID24112502
show ga
INTRODUCTION: The effect of parathyroidectomy on the incidence of recurrent stone
formation is uncertain. We aimed to compare the biochemistry and recurrence rate
of urolithiasis in patients with primary hyperparathyroidism (pHPT) and stone
formation (SF) and non-stone formation (NSF) with idiopathic stone formers (ISF).
METHODS: Patients with pHPT and SF (Group 1) were identified from a prospective
database. pHPT patients and NSF (Group 2) and ISFs (Group 3) were randomly
selected from respective databases to form three equal groups. Preoperative and
postoperative biochemical data were analysed and recurrent urolithiasis diagnosed
if present on follow-up radiology. Out-of-area patients were asked about
recurrence via telephone. RESULTS: From July 2002 to October 2011, 640 patients
had parathyroidectomy for pHPT. Of these, 66 (10.3%) had a history of renal
colic; one was lost to follow-up. Patient demographics were similar across all
three groups. Three months post-parathyroidectomy, Groups 1 and 2 had
significantly reduced serum calcium concentrations (p<0.01). Group 1 had lower
urinary calcium excretion after parathyroidectomy (p<0.01), but estimated
glomerular filtration rate did not change following surgery. During median
follow-up of 4.33 years (0.25-9 years) in Groups 1 and 2 and 5.08 years (0.810-8
years) in Group 3, one patient (1.5%) in Group 1 and 16 patients (25%) in Group 3
had recurrent urolithiasis (p<0.01). No Group 2 patients developed stones.
CONCLUSION: Curative parathyroidectomy confers a low recurrence rate for
urolithiasis, but does not prevent recurrence in all patients. Further research
should aim to identify the risk factors for continued SF in these patients.
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