Parathyroidectomy for nephrolithiasis in primary hyperparathyroidism: Beneficial but not a panacea
| Autor: | Siu-Yuan Huang, Raoul J. Burchette, Joanie Chung, Philip I. Haigh |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Adult
Male Parathyroidectomy medicine.medical_specialty Time Factors medicine.medical_treatment Kaplan-Meier Estimate Nephrolithiasis Disease-Free Survival Young Adult Recurrence Secondary Prevention medicine Humans In patient First Recurrence Aged Retrospective Studies Aged 80 and over business.industry Retrospective cohort study Middle Aged Hyperparathyroidism Primary medicine.disease Surgery Parathyroid Hormone Cohort Calcium Female business Primary hyperparathyroidism Follow-Up Studies |
| Zdroj: | Surgery. 171:29-34 |
| ISSN: | 0039-6060 |
| Popis: | Nephrolithiasis is a classic indication for parathyroidectomy in primary hyperparathyroidism patients; however, the effects of parathyroidectomy on nephrolithiasis recurrence are not well studied. The aim was to determine effect of parathyroidectomy on time to first nephrolithiasis recurrence and recurrence rate per patient-years.A retrospective cohort study of patients diagnosed with primary hyperparathyroidism and at least one episode of nephrolithiasis was performed. The patients were divided into observation, presurgery, and postsurgery groups. Endpoints were time to first recurrence of nephrolithiasis and average recurrence rate per patient-years.The cohort was comprised of 1,252 patients. In addition, 334 (27%) patients underwent parathyroidectomy and 918 (73%) were observed. The surgical and nonsurgical groups differed significantly in age, sex, Charlson, calcium, and primary hyperparathyroidism level. Overall recurrence rate was 31.3%. The 5-, 10-, and 15-year recurrence-free survival rates were 74.4%, 56.3%, 49.5%, respectively (presurgery), 82.4%, 70.9%, 62.8%, respectively (postsurgery; P.0001), and 86.3%, 77.7%, and 70.6%, respectively (observation). The presurgery group had an increased risk of first recurrence compared with the observation group (hazard ratio 1.89; 95% confidence interval, 1.44-2.47). The average recurrence rates among all surgical patients who recurred were 1 event per 4.3 patient-years presurgery versus 1 event per 6.7 patient-years postsurgery (P = .0001).Recurrent nephrolithiasis is a significant problem in patients with primary hyperparathyroidism. Parathyroidectomy prolongs the time to first recurrence and decreases the number of re-recurrences over time but does not eliminate recurrences. Observation may also be a reasonable approach in selected patients. |
| Databáze: | OpenAIRE |
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