Evaluating the incidence of nephrolithiasis surgery before and after parathyroidectomy

Primary hyperparathyroidism (PHPT) patients who undergo parathyroidectomy (PTX) have significantly reduced rates of kidney stone events based on imaging and patient-reported history. However, there has been limited knowledge on the impact of PTX on stone disease requiring surgical intervention. The aim of this study was to compare the incidence of kidney stone surgery before and after PTX.

PHPT patients who underwent PTX from 2015-2023 at our institution were retrospectively reviewed. We evaluated the incidence of kidney stone treatment by shockwave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) based on CPT codes. Univariate and multivariate analyses were performed to compare the incidence rate before and after PTX.

We included 1554 patients who underwent PTX and identified 101 kidney stone surgeries. Patients were 75% female, 16% non-white race and had a median age of 63 years (IQR 55-71) at the time of PTX. The median follow-up time was 5.2 years before and 3.3 years after PTX. The incidence of kidney stone surgery in patients pre- vs post-PTX was 80 events/7668 person-years (1.0%) vs 21 events/5318 person-years (0.4%) respectively, (p < 0.0001). Thus, the incidence rate of requiring stone surgery decreased by 2.64 times following PTX (95% CI 1.62-4.50, p < 0.0001). The cases of URS and SWL decreased whereas the cases of PCNL increased (p < 0.02).

The incidence of stone disease requiring surgical intervention significantly decreased following PTX. It remains critical to screen recurrent stone formers for PHPT, as surgical correction with PTX may help reduce subsequent stone surgeries and associated comorbidities.