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

## TL;DR

A study compared two kidney stone removal methods in children and found similar success rates but better recovery with shockwave lithotripsy.

## Contribution

The study provides real-world evidence on patient-reported outcomes and stone clearance for two common pediatric kidney stone treatments.

## Key findings

- Ureteroscopy and shockwave lithotripsy had similar stone clearance rates (71% vs 68%) in children and adolescents.
- Ureteroscopy was linked to more pain, urinary symptoms, and missed school compared to shockwave lithotripsy.
- Shockwave lithotripsy showed better patient-reported outcomes despite similar stone clearance.

## Abstract

What are the outcomes following ureteroscopy vs shockwave lithotripsy for kidney stone removal in children and adolescents?

In this nonrandomized clinical trial including 1142 children and adolescents who underwent kidney stone surgery at 31 North American centers, stone clearance occurred in 71% of patients who underwent ureteroscopy compared with 68% of those who underwent shockwave lithotripsy, but this difference was not statistically significant. Ureteroscopy was associated with greater pain interference, urinary symptoms, and missed school 1 week after surgery.

There was no clinically meaningful difference in kidney stone clearance with ureteroscopy vs shockwave lithotripsy, but shockwave lithotripsy was associated with better lived experience.

This nonrandomized clinical trial compares kidney stone clearance and patient-reported experiences among children and adolescents following ureteroscopy or shockwave lithotripsy.

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.

To compare stone clearance and patient-reported outcomes among children and adolescents after ureteroscopy or shockwave lithotripsy.

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.

Ureteroscopy or shockwave lithotripsy.

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.

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.

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.

ClinicalTrials.gov Identifier: NCT04285658