TY - JOUR
T1 - Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children
AU - PKIDS Care Improvement Network
AU - Ellison, Jonathan S
AU - Chu, David I
AU - Nelson, Caleb P
AU - DeFoor, W Robert
AU - Ziemba, Justin
AU - Huang, Jing
AU - Luan, Xianqun
AU - Kurtz, Michael
AU - Ching, Christina B
AU - Dangle, Pankaj P
AU - Schaeffer, Anthony J
AU - Sturm, Renea
AU - Wu, Wayland
AU - Bayne, Christopher
AU - Fernandez, Nicolas
AU - Chua, Michael E
AU - DeMarco, Romano
AU - Ellsworth, Pamela
AU - Augelli, Brian
AU - Bi-Karchin, Jing
AU - McCune, Rebecca D
AU - Vatsky, Seth
AU - Back, Susan
AU - Wang, Zi
AU - Beck, Hunter
AU - Kurth, Anna
AU - Kurth, Laura
AU - Pleskoff, Annabelle
AU - Forrest, Christopher B
AU - Tasian, Gregory E
AU - Rove, Kyle
AU - Sparks, Scott
AU - Nelson, Eric
AU - Schlomer, Bruce
AU - Krill, Aaron
AU - Tong, Ching Man Carmen
AU - Taylor, Abby
AU - Ramachandra, Puneeta
AU - Stec, Andrew
AU - Casale, Pasquale
AU - Coplen, Douglas
AU - Janzen, Nicolette
AU - Bagley, Krystal
AU - Denburg, Michelle
AU - Dickinson, Kimberley
AU - Laberee, Rosemary
AU - Lorenzo, Matt
AU - Selman-Fermin, Antoine
AU - Dos Santos, Joana
AU - Grant, Campbell
N1 - Publisher Copyright:
© 2025 American Medical Association. All rights reserved.
PY - 2025/6/20
Y1 - 2025/6/20
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/105009272019
U2 - 10.1001/jamanetworkopen.2025.16749
DO - 10.1001/jamanetworkopen.2025.16749
M3 - Article
C2 - 40540269
SN - 2574-3805
VL - 8
SP - e2516749
JO - JAMA network open
JF - JAMA network open
IS - 6
M1 - e2516749
ER -