[Surgery of hyperparathyroidism in urologic patients. Apropos of 76 surgically treated cases]

The author reports a homogeneous personal series of 76 cervical operations for hyperparathyroidism: 66 primary in patients with lithiasis and 10 tertiary in patients with chronic renal failure. There were 56 single adenomas, one double adenoma and 19 cases of diffuse hyperplasia treated in the majority of cases by total parathyroidectomy followed by microsurgical auto-transplant of parathyroid to the forearm. No damage to the recurrent laryngeal nerve. The author saw no secondary hypoparathyroidism and only one case of persistent hyperparathyroidism in a patient with chronic renal failure and on dialysis, and one recurrence of lithiasis. In general, removal of the parathyroids preceded surgery for lithiasis except where there was obstruction of the urinary tract. In 6 cases, treatment of hyperparathyroidism and of lithiasis was simultaneous at the same operation without complications. It is of interest to note the rarity of staghorn calculi in patients with hyperparathyroidism which makes simultaneous operation possible. From a technical standpoint, routine identification of the recurrent laryngeal nerves ensures that they will remain undamaged. The author recommends routine dissection of all 4 parathyroids, and removal of the one or possibly two large glands when the others perfectly identified are normal. The discovery of 3 or, even more so, 4 enlarged parathyroids implies a diagnosis of hyperplasia. Management should then consist of total parathyroidectomy of the 4 glands followed by auto-transplant of small fragments of one half-gland to the forearm. Surveillance of parathormone levels in the arm veins will provide subsequent information as to the function of the transplant.(ABSTRACT TRUNCATED AT 250 WORDS)