Effect of parathyroidectomy on stone recurrence in primary hyperparathyroidism : A systematic review

Primary hyperparathyroidism (pHPT) is infrequently associated with calcium-containing kidney stones, despite hypercalciuria. Parathyroidectomy (PTX) is the only curative treatment of the metabolic disorder and is indirectly regarded as prophylaxis of recurrence of stone formation. The aim of the systematic review was to evaluate the impact of PTX on stone recurrence and to identify possible predictors of recurrent stone formation.

Following PRISMA guidelines, a systematic PubMed search was conducted through April 2025. Eligible studies including adults with successfully surgically treated pHPT, documented nephrolithiasis and a follow-up of at least 12 months were analyzed.

A total of 13 studies (2 prospective cohorts, 10 retrospective cohorts, 1 randomized controlled trial, RCT) comprising more than 8000 patients met the inclusion criteria. After PTX, recurrence rates in prospective studies ranged from 0-30% among stone formers, while retrospective series showed a wider range (between 0% and 58%). Registry data indicated that in patients with a history of nephrolithiasis, the recurrence risk seems higher shortly after PTX compared with conservative management of pHPT but decreases substantially with each subsequent year. In patients without a stone history, de novo stone formation was rare; in the RCT, recurrence occurred in 0% after PTX versus 4% under observation. Consistent predictors of recurrence included persistent hypercalciuria, multiple preoperative stone episodes, hypocitraturia, elevated body mass index, and male sex.

The use of PTX significantly reduces the long-term risk of stone recurrence but does not eliminate it entirely. In patients with a history of nephrolithiasis, short-term risk may be elevated after PTX but declines markedly over time. Individualized follow-up including regular assessment of serum calcium, parathyroid hormone, renal function, and 24‑h urinary parameters, together with preventive measures where indicated, such as adequate fluid intake, dietary counselling, potassium citrate or thiazide therapy, is recommended, particularly in patients with persistent risk factors. Decisions regarding surgical treatment of existing kidney stones should be individualized based on stone size, location, symptoms, infection risk as well as the overall patient risk profile and life expectancy.