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.
To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones.
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.
Percutaneous nephrolithotomy vs ureteroscopy.
Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery.
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.
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.
JAMA network open. 2025 Jun 02*** epublish ***
Jonathan S Ellison, David I Chu, Caleb P Nelson, W Robert DeFoor, Justin Ziemba, Jing Huang, Xianqun Luan, Michael Kurtz, Christina B Ching, Pankaj P Dangle, Anthony J Schaeffer, Renea Sturm, Wayland Wu, Christopher Bayne, Nicolas Fernandez, Michael E Chua, Romano DeMarco, Pamela Ellsworth, Brian Augelli, Jing Bi-Karchin, Rebecca D McCune, Seth Vatsky, Susan Back, Zi Wang, Hunter Beck, Anna Kurth, Laura Kurth, Annabelle Pleskoff, Christopher B Forrest, Gregory E Tasian, PKIDS Care Improvement Network , Kyle Rove, Scott Sparks, Eric Nelson, Bruce Schlomer, Aaron Krill, Ching Man Carmen Tong, Abby Taylor, Puneeta Ramachandra, Andrew Stec, Pasquale Casale, Douglas Coplen, Nicolette Janzen, Krystal Bagley, Michelle Denburg, Kimberley Dickinson, Rosemary Laberee, Matt Lorenzo, Antoine Selman-Fermin, Joana Dos Santos, Campbell Grant, Kate Kraft, Bhalaajee Meenakshi-Sundaram
Department of Urology, Medical College of Wisconsin, Milwaukee., Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois., Department of Urology, Boston Children's Hospital, Boston, Massachusetts., Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia., Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia., PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Department of Pediatric Urology, Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio., Department of Pediatric Urology, Riley Hospital for Children, Indianapolis, Indiana., Division of Urology, Department of Surgery, University of Utah, Salt Lake City., Department of Pediatric Urology, Mattel Children's Hospital at UCLA (University of California, Los Angeles), Los Angeles., Department of Pediatric Urology, Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey., Department of Pediatric Urology, Carilion Children's Pediatric Urology, Roanoke, Virginia., Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington., Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada., Division of Pediatric Urology, Department of Urology, University of Florida, Gainesville., Nemours Children's Hospital and University of Central Florida College of Medicine, Orlando., Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Patient & Family Research Partners, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Division of Urology, Children's Hospital Colorado, Aurora., Division of Urology, Children's Hospital of Los Angeles, Los Angeles, California., Departments of Surgery and Urology, Children's Hospital of Richmond at VCU, Richmond, Virginia., Division of Urology, Children's National Hospital of Washington, DC, Washington, DC., Division of Urology, Children's Hospital of Alabama, Birmingham., Division of Urology, Nemours A. I. duPont Hospital for Children-Wilmington, Wilmington, Delaware., Division of Pediatric Urology, Nemours Children's Health, Jacksonville, Florida., Pediatric Urology, Nemours Children's Health, Delaware Valley, Wilmington., Division of Urology, St Louis Children's Hospital, St Louis, Missouri., Division of Urology, Texas Children's Hospital, Houston., Department of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Research Administration, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Division of Urology, Toronto SickKids, Toronto, Ontario, Canada., Division of Urology, University of Kentucky, Lexington., University of Michigan, Ann Arbor., University of Oklahoma Health Sciences Center, Oklahoma City.