The PKIDS Study: Comparative Effectiveness of Surgical Interventions for Pediatric Patients With Kidney Stones

2025-06-02

Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children

JAMA Network Open · 2025-06-20 · 7 citations

Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative. Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones. Design, Setting, and Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023. Exposures: Percutaneous nephrolithotomy vs ureteroscopy. Main Outcomes and Measures: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery. Results: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery. Conclusions and Relevance: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents

JAMA Network Open · 2025-08-07 · 1 citations

Importance: Most children and adolescents with kidney and ureteral stones are treated with ureteroscopy, despite the uncertainty and equal weight of guideline recommendations for ureteroscopy or shockwave lithotripsy. Objective: To compare stone clearance and patient-reported outcomes among children and adolescents after ureteroscopy or shockwave lithotripsy. Design, Setting, and Participants: This nonrandomized clinical trial enrolled patients between March 16, 2020, and July 31, 2023, at 31 medical centers in the US and Canada. Patients aged 8 to 21 years with kidney stones, ureteral stones, or both were included. Follow-up was completed on October 15, 2023. Interventions: Ureteroscopy or shockwave lithotripsy. Main Outcomes and Measures: The primary outcome was stone clearance assessed by standardized ultrasonography 6 (±2) weeks after surgery. Using inverse probability weighting and random intercepts for site, stone clearance was evaluated per kidney or ureter using logistic regression and estimated stone clearance rates were generated for each procedure. Results: This study included 1142 patients (690 females [60.4%]), with a median age of 15.6 years (IQR, 12.6-17.3 years). In terms of race and ethnicity, 41 patients (3.6%) were Black, 130 (11.4%) were Hispanic, and 884 (77.4%) were White. A total of 124 urologists treated 1069 and 197 kidneys or ureters with ureteroscopy and shockwave lithotripsy (n = 953 and n = 189 patients), respectively, with a median stone size of 6.0 mm (IQR, 4.0-9.0 mm). Ureteral stents were placed at time of index surgery for 841 procedures for 767 patients (80.4%) receiving ureteroscopy and for 6 procedures for 5 patients (2.6%) receiving shockwave lithotripsy. Stone clearance occurred in 474 patients who underwent ureteroscopy (71.2% [95% CI, 63.8%-78.5%]) and in 105 patients who underwent shockwave lithotripsy (67.5% [95% CI, 61.0%-74.1%]), a difference that was not statistically significant (risk difference, 3.6% [95% CI, -6.2% to 13.5%]). Compared with shockwave lithotripsy, ureteroscopy resulted in greater pain interference (T-score difference, 5.0 [95% CI, 2.3-7.8]) and urinary symptoms (symptom score difference, 3.9 [95% CI, 1.2-6.7]) 1 week after surgery. Patients who had ureteroscopy missed more school (risk difference, 21.3% [95% CI, 9.7%-32.8%]) and caregivers missed more work (risk difference, 23.0% [95% CI, 11.0%-35.0%]) in the week after surgery. Conclusions and Relevance: In this study of 1142 children and adolescents with kidney and ureteral stones, there was no clinically meaningful difference in stone clearance with ureteroscopy vs shockwave lithotripsy. Shockwave lithotripsy was associated with better patient-reported outcomes. These findings raise questions about the preference for ureteroscopy in practice. Trial Registration: ClinicalTrials.gov Identifier: NCT04285658.

P2-09 COMPARATIVE EFFECTIVENESS OF URETEROSCOPY AND SHOCKWAVE LITHOTRIPSY FOR CHILDREN WITH NEPHROLITHIASIS: RESULTS OF A MULTICENTER PROSPECTIVE CLINICAL TRIAL

The Journal of Urology · 2024-05-01 · 1 citations

You have accessJournal of UrologyParadigm-shifting, Practice-changing Clinical Trials in Urology (P2)1 May 2024P2-09 COMPARATIVE EFFECTIVENESS OF URETEROSCOPY AND SHOCKWAVE LITHOTRIPSY FOR CHILDREN WITH NEPHROLITHIASIS: RESULTS OF A MULTICENTER PROSPECTIVE CLINICAL TRIAL Carmen Tong, Renea Sturm, Kyle Rove, Puneeta Ramachandra, Aaron Krill, Pasquale Casale, Pamela Ellsworth, Andrew Stec, Christopher Bayne, David Chu, Caleb Nelson, Douglas Coplen, William DeFoor, Christina Ching, Abby Taylor, Bruce Schlomer, Nicolette Janzen, Eric Nelson, Nicolas Fernandez, Pankaj Dangle, Kate Kraft, Bhalaajee Meenakshi-Sundaram, Michael Chua, Wayland Wu, Scott Sparks, Campbell Grant, Anthony Schaeffer, Justin Ziemba, Ryan Hsi, Rebecca D. McCune, Jing Karchin, Brian Augelli, Kimberley Dickinson, Susan Back, Michelle Denburg, Christopher Forrest, Matt Lorenzo, Krystal Bagley, Antoine Selman-Fermin, Jing Huang, Xianqun Luan, Zi Wang, Rosemary Labaree, Carrie Matson, Anna Kurth, Laura Kurth, Hunter Beck, Annabelle Pleskoff, Ruth Beck, Jonathan Ellison, and Gregory E. Tasian Carmen TongCarmen Tong , Renea SturmRenea Sturm , Kyle RoveKyle Rove , Puneeta RamachandraPuneeta Ramachandra , Aaron KrillAaron Krill , Pasquale CasalePasquale Casale , Pamela EllsworthPamela Ellsworth , Andrew StecAndrew Stec , Christopher BayneChristopher Bayne , David ChuDavid Chu , Caleb NelsonCaleb Nelson , Douglas CoplenDouglas Coplen , William DeFoorWilliam DeFoor , Christina ChingChristina Ching , Abby TaylorAbby Taylor , Bruce SchlomerBruce Schlomer , Nicolette JanzenNicolette Janzen , Eric NelsonEric Nelson , Nicolas FernandezNicolas Fernandez , Pankaj DanglePankaj Dangle , Kate KraftKate Kraft , Bhalaajee Meenakshi-SundaramBhalaajee Meenakshi-Sundaram , Michael ChuaMichael Chua , Wayland WuWayland Wu , Scott SparksScott Sparks , Campbell GrantCampbell Grant , Anthony SchaefferAnthony Schaeffer , Justin ZiembaJustin Ziemba , Ryan HsiRyan Hsi , Rebecca D. McCuneRebecca D. McCune , Jing KarchinJing Karchin , Brian AugelliBrian Augelli , Kimberley DickinsonKimberley Dickinson , Susan BackSusan Back , Michelle DenburgMichelle Denburg , Christopher ForrestChristopher Forrest , Matt LorenzoMatt Lorenzo , Krystal BagleyKrystal Bagley , Antoine Selman-FerminAntoine Selman-Fermin , Jing HuangJing Huang , Xianqun LuanXianqun Luan , Zi WangZi Wang , Rosemary LabareeRosemary Labaree , Carrie MatsonCarrie Matson , Anna KurthAnna Kurth , Laura KurthLaura Kurth , Hunter BeckHunter Beck , Annabelle PleskoffAnnabelle Pleskoff , Ruth BeckRuth Beck , Jonathan EllisonJonathan Ellison , and Gregory E. TasianGregory E. Tasian View All Author Informationhttps://doi.org/10.1097/01.JU.0001015816.87470.c9.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract BACKGROUND: AUA and EAU guidelines recommend ureteroscopy (URS) or shockwave lithotripsy (SWL) for pediatric patients with kidney stones <20 mm and for ureteral stones based on low-level evidence for stone clearance and no evidence on patient reported outcomes (PROs). Despite equal weight of the recommendations, 80% of children have URS for these stones. METHODS: The Pediatric KIDney Stone (PKIDS) Care Improvement Network embedded a prospective observational trial of patients aged 8-21 years in clinical care at 30 medical centers in North America from 2020-2023 to compare URS and SWL for kidney and ureteral stones. The primary outcome was stone clearance assessed by ultrasound 6 (±2) weeks after surgery considering heterogeneity of treatment effect (HTE) by a priori categories of stone size (<7 mm, 7-10 mm, 10-15 mm, and >15 mm) and location (ureter/UPJ, non-lower pole kidney, and lower pole kidney). Secondary outcomes were PROs measured by PROMIS and urinary symptom scores at 1, 3, 6 and 12 weeks after surgery, assessing HTE by age and sex. Stone clearance and PROs were compared using generalized linear models and ANCOVA, respectively, weighted with inverse propensity scores to balance patient, surgeon, and institutional characteristics across groups. RESULTS: Among 1142 patients (median age of 15.6 years; 690 were female (60%); 884 were White (77%), 41 were Black (4%), 130 were Hispanic (11%), 1070 and 197 kidneys with a median stone size of 6 mm (IQR 4, 9) were treated with SWL performed by 125 urologists. For all stone sizes, stone clearance was 74.5% for URS (95% CI, 65.7 to 83.3) and 68.6% for SWL (95% CI, 59.7 to 77.7), which was not statistically different (risk difference 5.9; 95% CI -6.6 to 18.5). Compared to URS, SWL resulted in less pain intensity, pain interference, and urinary symptoms one week after surgery, adjusting for pre-operative symptoms (Table). There were no differences between treatments for any PROs from 3 weeks until the last survey 3 months after surgery. In HTE analyses, there were no differences in stone clearance by size or location. Stone clearance could not be compared for stones >15 mm as only 3 patients had SWL for these stones. Patients aged 18-21 years treated with URS had worse urinary symptoms one week after surgery than younger patients. There were no sex differences in PROs between treatments. CONCLUSIONS: Among pediatric patients with kidney and ureteral stones, SWL resulted in similar stone clearance and better lived experiences than URS. These findings support SWL for children and adolescents with small to medium sized urinary stones. Source of Funding: This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Project Program Award (CER-2018C3-14778) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5S2May 2024Page: e6 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carmen Tong More articles by this author Renea Sturm More articles by this author Kyle Rove More articles by this author Puneeta Ramachandra More articles by this author Aaron Krill More articles by this author Pasquale Casale More articles by this author Pamela Ellsworth More articles by this author Andrew Stec More articles by this author Christopher Bayne More articles by this author David Chu More articles by this author Caleb Nelson More articles by this author Douglas Coplen More articles by this author William DeFoor More articles by this author Christina Ching More articles by this author Abby Taylor More articles by this author Bruce Schlomer More articles by this author Nicolette Janzen More articles by this author Eric Nelson More articles by this author Nicolas Fernandez More articles by this author Pankaj Dangle More articles by this author Kate Kraft More articles by this author Bhalaajee Meenakshi-Sundaram More articles by this author Michael Chua More articles by this author Wayland Wu More articles by this author Scott Sparks More articles by this author Campbell Grant More articles by this author Anthony Schaeffer More articles by this author Justin Ziemba More articles by this author Ryan Hsi More articles by this author Rebecca D. McCune More articles by this author Jing Karchin More articles by this author Brian Augelli More articles by this author Kimberley Dickinson More articles by this author Susan Back More articles by this author Michelle Denburg More articles by this author Christopher Forrest More articles by this author Matt Lorenzo More articles by this author Krystal Bagley More articles by this author Antoine Selman-Fermin More articles by this author Jing Huang More articles by this author Xianqun Luan More articles by this author Zi Wang More articles by this author Rosemary Labaree More articles by this author Carrie Matson More articles by this author Anna Kurth More articles by this author Laura Kurth More articles by this author Hunter Beck More articles by this author Annabelle Pleskoff More articles by this author Ruth Beck More articles by this author Jonathan Ellison More articles by this author Gregory E. 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Robotic Pediatric Renal Surgery

2022-01-01 · 1 citations

Conversion to open surgery remains minimal despite growing use of laparoscopic or robotic nephrectomy

European Urology Open Science · 2020-09-18

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Author Correction: The copy number variation landscape of congenital anomalies of the kidney and urinary tract

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Robot-Assisted ureteroplasty and ureteral reimplantation for nonrefluxing primary obstructing megaureter

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