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Observational Study
. 2025 Aug 1;8(8):e2525789.
doi: 10.1001/jamanetworkopen.2025.25789.

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
Affiliations
Observational Study

Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents: A Nonrandomized Clinical Trial

Gregory E Tasian et al. JAMA Netw Open. .

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.

Trial registration: ClinicalTrials.gov Identifier: NCT04285658.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Tasian reported receiving grants from the Patient-Centered Outcomes Research Institute (PCORI) during the conduct of the study. In addition, Dr Tasian reported serving on scientific advisory boards of Alnylam Pharmaceuticals and Novo Nordisk outside the submitted work. Dr Chu reported receiving grants from PCORI and the National Institutes of Health (NIH) during the conduct of the study. Dr C. P. Nelson reported receiving grants from PCORI during the conduct of the study. Dr DeFoor reported investing in American Kidney Stone Management outside the submitted work. Dr Back reported receiving grants from Bracco Diagnostics and contracting with Philips Ultrasound outside the submitted work. Dr Ellison reported receiving grants from PCORI during the conduct of the study and receiving personal fees from UpToDate outside the submitted work. Dr Rove reported receiving grants from Sumitomo Pharma and acting as the site principal investigator at Children’s Hospital Colorado for the KANGUROO study (NCT05491525) outside the submitted work. Dr Tong reported receiving personal fees from Novo Nordisk outside the submitted work. Dr Denburg reported receiving grants from PCORI during the conduct of the study and serving on the Kidney Disease Improving Global Outcomes Executive Committee and as Associate Editor for the Journal of the American Society of Nephrology outside the submitted work. Dr Ellison reported receiving grants from PCORI during the conduct of the study and receiving personal fees from UpToDate outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram of Patients Who Underwent Ureteroscopy or Shockwave Lithotripsy for Kidney Stone Removal
aParticipants did not receive ureteroscopy or shockwave lithotripsy. bParticipants who withdrew but allowed data collection remained in the analysis cohort. cStone clearance evaluated at the kidney level. dTreatment group allocation and patient-reported outcome (PRO) evaluation are at the patient level. eUltrasonography studies either reported no stone present or had measured stone size.
See this image and copyright information in PMC

References

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