Researchers from Children’s Hospital of Philadelphia (CHOP), in collaboration with several academic partners, have released the primary results of the Pediatric KIDney Stone (PKIDS) trial. This is described as the largest comparative effectiveness study to date on surgical interventions for children and adolescents with kidney stones. The PKIDS trial, led by CHOP, produced two studies published in JAMA Network Open that provide new evidence about treatment outcomes for kidney stones of different sizes and include information on patient experiences after surgery.
Kidney stones, which are hard deposits formed from minerals in urine, were once mostly seen in adults but have become increasingly common among children over recent decades. In response to this trend, CHOP established the PKIDS Care Improvement Network in 2019. The network now includes 31 sites across the United States and Canada.
The main procedures used to treat kidney stones are ureteroscopy (an endoscopic outpatient procedure), shockwave lithotripsy (a noninvasive outpatient procedure), and percutaneous nephrolithotomy (a minimally invasive surgery involving a short hospital stay). Despite uncertainty about which method is most effective or has fewer impacts on patients’ lives, most pediatric cases are treated with ureteroscopy.
One study enrolled 1,142 patients aged 8 to 21 years old with kidney or ureteral stones between 2020 and 2023 at all participating sites. Researchers compared ureteroscopy with shockwave lithotripsy and found that while both procedures were equally effective at removing stones, those who underwent shockwave lithotripsy experienced less pain and fewer urinary symptoms after surgery.
A second study compared percutaneous nephrolithotomy (PCNL) with ureteroscopy for children with larger stones. The findings indicated that PCNL was more effective at clearing large stones and resulted in better overall recovery experiences than ureteroscopy.
Authors of these studies highlighted the importance of considering post-surgery quality-of-life factors such as school time lost by children and work time lost by caregivers when determining appropriate treatment options. Further research is planned; however, researchers hope these results will lead to immediate improvements for families making decisions about kidney stone treatments.
Gregory E. Tasian, MD, MSc, MSCE stated: “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 E. Tasian, MD, MSc, MSCE, Director of the PKIDS network and an attending pediatric urologist in the Division of Urology at Children’s Hospital of Philadelphia. “Although future clinical trials are important, we hope that clinical practice guidelines will consider outcomes that matter to patients.”
The study received support through a Patient-Centered Outcomes Research Institute funding award.
Tasian et al.’s study “Ureteroscopy versus Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents: A Nonrandomized Clinical Trial” was published online August 7, 2025 in JAMA Network Open.
