Shockwave Lithotripsy for Pediatric Kidney Stones Linked to Faster Recovery, Less Pain

New research is challenging the preference for ureteroscopy for the treatment of pediatric kidney stones in clinical practice, with study findings suggesting shockwave lithotripsy may provide similar rates of stone clearance with faster recovery time and better patient-reported outcomes.1

The Pediatric KIDney Stone (PKIDS) Study included > 1000 children and adolescents who underwent kidney stone surgery at 31 North American centers and found ureteroscopy was associated with greater pain interference, urinary symptoms, and missed school 1 week after surgery compared with shockwave lithotripsy. Of note, there was no clinically meaningful difference in kidney stone clearance between the procedures.1

Current guidelines from the American Urological Association recommend ureteroscopy or shockwave lithotripsy for pediatric patients with ureteral stones and kidney stones < 20 mm. However, this is based on low-quality evidence from observational studies and randomized clinical trials, none of which considered patient experiences after surgery.1,2

“The PKIDS trial demonstrated that ureteroscopy and shockwave lithotripsy remove stones equally well and that patients having shockwave lithotripsy recover more quickly after surgery with less pain and fewer urinary symptoms. Our findings provide new information that allow for tailored approaches to kidney stone treatment for children and their families,” said Gregory Tasian, MD, MSc, director of the PKIDS network and an attending pediatric urologist in the division of urology at Children's Hospital of Philadelphia.3 “Although future clinical trials are important, we hope that clinical practice guidelines will consider outcomes that matter to patients.”

An investigator-initiated, nonrandomized clinical trial embedded in the clinical care of children and adolescents undergoing kidney stone surgery between March 2020 and July 2023, PKIDS enrolled patients 8 to 21 years of age undergoing ureteroscopy or shockwave lithotripsy for unilateral or bilateral kidney stones at 31 medical centers in 22 US states and 1 Canadian province that participate in the PKIDS Network.1

Treatment type was a clinical decision made by the urologist and patient or caregiver and was performed per the urologist’s discretion. The primary outcome was stone clearance, defined as the absence of any stone > 4 mm in the operated kidney or ureter on ultrasonography 6 (±2) weeks after surgery.1

In total, the study included 1142 patients with a median age of 15.6 (interquartile range [IQR], 12.6-17.3) years, the majority of whom were female (60.4%) and White (77.4%). 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).1

Investigators noted 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.1

Results showed stone clearance occurred in 474 patients who underwent ureteroscopy (71.2%; 95% CI, 63.8% to 78.5%) and in 105 patients who underwent shockwave lithotripsy (67.5%; 95% CI, 61.0% to 74.1%), although investigators pointed out this difference was not statistically significant (risk difference, 3.6%; 95% CI, −6.2% to 13.5%).1

Compared with shockwave lithotripsy, ureteroscopy resulted in greater pain interference (T-score difference, 5.0; 95% CI, 2.3 to 7.8) and urinary symptoms (symptom score difference, 3.9; 95% CI, 1.2 to 6.7) 1 week after surgery. Further analysis revealed patients who had ureteroscopy missed more school (risk difference, 21.3%; 95% CI, 9.7% to 32.8%) and caregivers missed more work (risk difference, 23.0%; 95% CI, 11.0% to 35.0%) in the week after surgery.1

“This evidence generated from contemporary clinical care calls into question current clinical practice, wherein most children and adolescents with kidney stones receive ureteroscopy,” investigators concluded.1

References

1. Tasian GE, Chu DI, Nelson CP, et al. Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents: A Nonrandomized Clinical Trial. JAMA Netw Open. 2025;8(8):e2525789. doi:10.1001/jamanetworkopen.2025.25789

2. Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society guideline, part I. J Urol. 2016;196(4):1153-1160. doi:10.1016/j.juro.2016.05.090

3. Children’s Hospital of Philadelphia. Children’s Hospital of Philadelphia Researchers Lead Largest Comparative Study of Surgical Interventions for Children and Adolescents with Kidney Stones. Newswise. August 7, 2025. Accessed August 14, 2025. https://www.newswise.com/articles/children-s-hospital-of-philadelphia-researchers-lead-largest-comparative-study-of-surgical-interventions-for-children-and-adolescents-with-kidney-stones