OBJECTIVE: To assess the determinants of urolithiasis in patients with primary hyperparathyroidism (PHPT) before and after parathyroidectomy (PTX).
METHODS: Institutional Research Ethics approval was obtained. A retrospective review was performed for patients presenting with PHPT to the stone, surgical oncology, and otolaryngology clinics at 2 tertiary-care centers from January 2006 to November 2011. Demographic, clinical, and surgical data were collected together with 24-hour urine collections before and after PTX.
RESULTS: Of 332 patients undergoing PTX, 255 (68.2% female patients) had PHPT. Mean age was 60.3 years (range, 18-91). Before PTX, renal calcification was detected in 51 (20%) patients, nephrolithiasis in 48 (18.8%), and nephrocalcinosis in 3 (1.2%) patients. Compared with PHPT patients without stones, PHPT patients with stones were significantly younger (56.4 vs 61.3 years, P = .02), less likely to be female (54.9% vs 71.9%, P = .03), and had significantly lower levels of vitamin D (19.7 vs 23.5 ng/mL, P = .03). Nine patients (3.5%) developed stones after PTX and were found to have significantly higher post-PTX total serum calcium levels when compared with those without stones. Although hypercalciuria was detected in 62% of pre-PTX stone formers, none of those who tested had post-PTX hypercalciuria (P < .001). On multivariate regression analysis, post-PTX stone formation was associated with male gender (adjusted odds ratio (95% confidence interval): 6.8 (5.3-7.2), P = .01) and post-PTX hypercalcemia (adjusted odds ratio (95% confidence interval): 1.48 (1.33-2.12), P = .02).
CONCLUSION: Pre-PTX urolithiasis was associated with younger age, male gender, and lower levels of vitamin D, whereas post-PTX urolithiasis was independently predicted by male gender and hypercalcemia.
Written by:
Elkoushy MA, Yu AX, Tabah R, Payne RJ, Dragomir A, Andonian S. Are you the author?
Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Urology, Suez Canal University, Ismailia, Egypt; Division of Surgical Oncology, Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology/Head and Neck Surgery, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Reference: Urology. 2014 Apr 2. pii: S0090-4295(14)00060-0.
doi: 10.1016/j.urology.2014.01.016
PubMed Abstract
PMID: 24703459
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