Tasian GE. et al., 2025: Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents: A Nonrandomized Clinical Trial.

Gregory E Tasian 1 2, David I Chu 3, Caleb P Nelson 4, W Robert DeFoor 5, Justin B Ziemba 6, Jing Huang 2, Xianqun Luan 2, Michael Kurtz 4, Christina B Ching 7, Pankaj Dangle 8, Anthony J Schaeffer 9, Renea Sturm 10, Wayland Wu 11, Christopher Bayne 12, Nicolas Fernandez 13, Michael E Chua 14, Romano DeMarco 15, Pamela Ellsworth 16, Brian Augelli 1, Jing Bi-Karchin 1, Rebecca D McCune 1, Seth Vatsky 17, Susan Back 17, Zi Wang 2, Hunter Beck 18, Anna Kurth 18, Laura Kurth 18, Annabelle Pleskoff 18, Christopher B Forrest 19, Jonathan S Ellison 20; PKIDS Care Improvement Network; Kyle Rove 21, Scott Sparks 22, Eric Nelson 23, Bruce Schlomer 24, Aaron Krill 25, Ching Man Carmen Tong 26, Abby Taylor 27, Puneeta Ramachandra 28, Andrew Stec 29, Pasquale Casale 30, Douglas Coplen 31, Nicolette Janzen 32, Krystal Bagley 33, Michelle R Denburg 33, Kimberley Dickinson 34, Rosemary Laberee 33, Matt Lorenzo 33, Antoine Selman-Fermin 33, Joana Dos Santos 14, Campbell Grant 35, Kate Kraft 36, Bhalaajee Meenakshi-Sundaram 37
1Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
2Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
3Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
4Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
5Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
6Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
7Department of Pediatric Urology, Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio.
8Department of Pediatric Urology, Riley Hospital for Children, Indianapolis, Indiana.
9Division of Urology, Department of Surgery, University of Utah, Salt Lake City.
10Department of Pediatric Urology, Mattel Children's Hospital at UCLA, Los Angeles, California.
11Department of Pediatric Urology, Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
12Department of Pediatric Urology, Carilion Children's Pediatric Urology, Roanoke, Virginia.
13Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington.
14Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
15Division of Pediatric Urology, Department of Urology, University of Florida, Gainesville.
16Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando.
17Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
18Patient and Family Research Partners, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
19Department of Pediatrics, Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
20Division of Pediatric Urology, Department of Urology, Medical College of Wisconsin, Milwaukee.
21Department of Pediatric Urology, Children's Hospital Colorado, Aurora.
22Division of Urology, Children's Hospital Los Angeles, Los Angeles, California.
23Division of Urology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond.
24Department of Urology, University of Texas Southwestern, Dallas.
25Department of Urology, Children's National Hospital of Washington, Washington, DC.
26Department of Urology, University of Alabama, Birmingham.
27Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
28Division of Urology, Nemours A. I. DuPont Hospital for Children, Wilmington, Delaware.
29Division of Urology, Nemours Children's Health, Jacksonville, Florida.
30Division of Urology, Nemours Children's Health, Delaware Valley, Wilmington, Delaware.
31Division of Urology, St Louis Children's Hospital, St Louis, Missouri.
32Division of Urology, Texas Children's Hospital, Houston.
33Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
34Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
35Department of Urology, University of Kentucky, Lexington.
36Department of Urology, University of Michigan, Ann Arbor.
37Department of Urology, University of Oklahoma Health Sciences, Oklahoma City.

Abstract

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.

JAMA Netw Open. 2025 Aug 1;8(8):e2525789. doi: 10.1001/jamanetworkopen.2025.25789.
PMID: 40773197; PMCID: PMC12332628 FREE TEXT