Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children

Jonathan S. Ellison; David I. Chu; Caleb P. Nelson; W. Robert Defoor; Justin Ziemba; Jing Huang; Xianqun Luan; Michael Kurtz; Christina B. Ching; Pankaj P. Dangle; Anthony J. Schaeffer; Renea Sturm; Wayland Wu; Christopher Bayne; Nicolas Fernandez; Michael E. Chua; Romano Demarco; Pamela Ellsworth; Brian Augelli; Jing Bi-Karchin; Rebecca D. McCune; Seth Vatsky; Susan Back; Zi Wang; Hunter Beck; Anna Kurth; Laura Kurth; Annabelle Pleskoff; Christopher B. Forrest; Gregory E. Tasian; Kyle Rove; Scott Sparks; Eric Nelson; Bruce Schlomer; Aaron Krill; Ching Man Carmen Tong; Abby Taylor; Puneeta Ramachandra; Andrew Stec; Pasquale Casale; Douglas Coplen; Nicolette Janzen; Krystal Bagley; Michelle Denburg; Kimberley Dickinson; Rosemary Laberee; Matt Lorenzo; Antoine Selman-Fermin; Joana Dos Santos; Campbell Grant; Kate Kraft; Bhalaajee Meenakshi-Sundaram

doi:10.1001/jamanetworkopen.2025.16749

Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children

Jonathan S. Ellison, David I. Chu, Caleb P. Nelson, W. Robert Defoor, Justin Ziemba, Jing Huang, Xianqun Luan, Michael Kurtz, Christina B. Ching, Pankaj P. Dangle, Anthony J. Schaeffer, Renea Sturm, Wayland Wu, Christopher Bayne, Nicolas Fernandez, Michael E. Chua, Romano Demarco, Pamela Ellsworth, Brian Augelli, Jing Bi-KarchinRebecca D. McCune, Seth Vatsky, Susan Back, Zi Wang, Hunter Beck, Anna Kurth, Laura Kurth, Annabelle Pleskoff, Christopher B. Forrest, Gregory E. Tasian, Kyle Rove, Scott Sparks, Eric Nelson, Bruce Schlomer, Aaron Krill, Ching Man Carmen Tong, Abby Taylor, Puneeta Ramachandra, Andrew Stec, Pasquale Casale, Douglas Coplen, Nicolette Janzen, Krystal Bagley, Michelle Denburg, Kimberley Dickinson, Rosemary Laberee, Matt Lorenzo, Antoine Selman-Fermin, Joana Dos Santos, Campbell Grant, Kate Kraft, Bhalaajee Meenakshi-Sundaram

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative. Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones. Design, Setting, and Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023. Exposures: Percutaneous nephrolithotomy vs ureteroscopy. Main Outcomes and Measures: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery. Results: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery. Conclusions and Relevance: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

Original language	English
Article number	e2516749
Journal	JAMA network open
Volume	8
Issue number	6
DOIs	https://doi.org/10.1001/jamanetworkopen.2025.16749
State	Published - Jun 20 2025

Bibliographical note

Publisher Copyright:
© 2025 American Medical Association. All rights reserved.

Funding

Funding/Support: This work was supported through program award CER-2018C3-14778 from the Patient-Centered Outcomes Research Institute (PCORI) (principal investigator, Dr Tasian) and career development award DK119535 from the National Institutes of Health (Dr Schaeffer). The American Urological Association guidelines for the surgical management of urinary stones recommend percutaneous nephrolithotomy or shockwave lithotripsy as equivalent treatments for pediatric patients with kidney stones 20 mm or larger, with no mention of ureteroscopy. These guidelines are supported only by expert opinion and do not reflect contemporary surgical treatment of large kidney stones in children and adolescents.

Funders	Funder number
American Urological Association
National Institutes of Health (NIH)
Patient-Centered Outcomes Research Institute	DK119535

ASJC Scopus subject areas

General Medicine

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10.1001/jamanetworkopen.2025.16749

Cite this

Ellison, J. S., Chu, D. I., Nelson, C. P., Defoor, W. R., Ziemba, J., Huang, J., Luan, X., Kurtz, M., Ching, C. B., Dangle, P. P., Schaeffer, A. J., Sturm, R., Wu, W., Bayne, C., Fernandez, N., Chua, M. E., Demarco, R., Ellsworth, P., Augelli, B., ... Meenakshi-Sundaram, B. (2025). Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children. JAMA network open, 8(6), Article e2516749. https://doi.org/10.1001/jamanetworkopen.2025.16749

@article{2104f7f82a6c440d9df16e7f48b7fc8f,

title = "Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children",

abstract = "Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative. Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones. Design, Setting, and Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023. Exposures: Percutaneous nephrolithotomy vs ureteroscopy. Main Outcomes and Measures: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery. Results: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5\%]; 40 Black [3.8\%]; 128 Hispanic [12.3\%]; and 792 White [76.2\%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2\% (95\% CI, 46.0\%-88.4\%) for percutaneous nephrolithotomy and 73.4\% (95\% CI, 69.4\%-77.4\%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2\%; 95\% CI, -27.7\% to 15.4\%). For stones larger than 15 mm, stone clearance was 94.0\% (95\% CI, 83.3\%-100\%) for percutaneous nephrolithotomy and 55.0\% (95\% CI, 32.9\%-77.1\%) for ureteroscopy, a statistically significant difference (risk difference, 39.0\%; 95\% CI, 14.4\%-63.5\%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95\% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95\% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95\% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95\% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95\% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95\% CI, -11.71 to -1.03) 1 week after surgery. Conclusions and Relevance: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.",

author = "Ellison, \{Jonathan S.\} and Chu, \{David I.\} and Nelson, \{Caleb P.\} and Defoor, \{W. Robert\} and Justin Ziemba and Jing Huang and Xianqun Luan and Michael Kurtz and Ching, \{Christina B.\} and Dangle, \{Pankaj P.\} and Schaeffer, \{Anthony J.\} and Renea Sturm and Wayland Wu and Christopher Bayne and Nicolas Fernandez and Chua, \{Michael E.\} and Romano Demarco and Pamela Ellsworth and Brian Augelli and Jing Bi-Karchin and McCune, \{Rebecca D.\} and Seth Vatsky and Susan Back and Zi Wang and Hunter Beck and Anna Kurth and Laura Kurth and Annabelle Pleskoff and Forrest, \{Christopher B.\} and Tasian, \{Gregory E.\} and Kyle Rove and Scott Sparks and Eric Nelson and Bruce Schlomer and Aaron Krill and Tong, \{Ching Man Carmen\} and Abby Taylor and Puneeta Ramachandra and Andrew Stec and Pasquale Casale and Douglas Coplen and Nicolette Janzen and Krystal Bagley and Michelle Denburg and Kimberley Dickinson and Rosemary Laberee and Matt Lorenzo and Antoine Selman-Fermin and \{Dos Santos\}, Joana and Campbell Grant and Kate Kraft and Bhalaajee Meenakshi-Sundaram",

year = "2025",

month = jun,

day = "20",

doi = "10.1001/jamanetworkopen.2025.16749",

language = "English",

volume = "8",

number = "6",

}

Ellison, JS, Chu, DI, Nelson, CP, Defoor, WR, Ziemba, J, Huang, J, Luan, X, Kurtz, M, Ching, CB, Dangle, PP, Schaeffer, AJ, Sturm, R, Wu, W, Bayne, C, Fernandez, N, Chua, ME, Demarco, R, Ellsworth, P, Augelli, B, Bi-Karchin, J, McCune, RD, Vatsky, S, Back, S, Wang, Z, Beck, H, Kurth, A, Kurth, L, Pleskoff, A, Forrest, CB, Tasian, GE, Rove, K, Sparks, S, Nelson, E, Schlomer, B, Krill, A, Tong, CMC, Taylor, A, Ramachandra, P, Stec, A, Casale, P, Coplen, D, Janzen, N, Bagley, K, Denburg, M, Dickinson, K, Laberee, R, Lorenzo, M, Selman-Fermin, A, Dos Santos, J, Grant, C, Kraft, K & Meenakshi-Sundaram, B 2025, 'Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children', JAMA network open, vol. 8, no. 6, e2516749. https://doi.org/10.1001/jamanetworkopen.2025.16749

TY - JOUR

T1 - Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children

AU - Ellison, Jonathan S.

AU - Chu, David I.

AU - Nelson, Caleb P.

AU - Defoor, W. Robert

AU - Ziemba, Justin

AU - Huang, Jing

AU - Luan, Xianqun

AU - Kurtz, Michael

AU - Ching, Christina B.

AU - Dangle, Pankaj P.

AU - Schaeffer, Anthony J.

AU - Sturm, Renea

AU - Wu, Wayland

AU - Bayne, Christopher

AU - Fernandez, Nicolas

AU - Chua, Michael E.

AU - Demarco, Romano

AU - Ellsworth, Pamela

AU - Augelli, Brian

AU - Bi-Karchin, Jing

AU - McCune, Rebecca D.

AU - Vatsky, Seth

AU - Back, Susan

AU - Wang, Zi

AU - Beck, Hunter

AU - Kurth, Anna

AU - Kurth, Laura

AU - Pleskoff, Annabelle

AU - Forrest, Christopher B.

AU - Tasian, Gregory E.

AU - Rove, Kyle

AU - Sparks, Scott

AU - Nelson, Eric

AU - Schlomer, Bruce

AU - Krill, Aaron

AU - Tong, Ching Man Carmen

AU - Taylor, Abby

AU - Ramachandra, Puneeta

AU - Stec, Andrew

AU - Casale, Pasquale

AU - Coplen, Douglas

AU - Janzen, Nicolette

AU - Bagley, Krystal

AU - Denburg, Michelle

AU - Dickinson, Kimberley

AU - Laberee, Rosemary

AU - Lorenzo, Matt

AU - Selman-Fermin, Antoine

AU - Dos Santos, Joana

AU - Grant, Campbell

AU - Kraft, Kate

AU - Meenakshi-Sundaram, Bhalaajee

PY - 2025/6/20

Y1 - 2025/6/20

N2 - Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative. Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones. Design, Setting, and Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023. Exposures: Percutaneous nephrolithotomy vs ureteroscopy. Main Outcomes and Measures: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery. Results: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery. Conclusions and Relevance: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

AB - Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative. Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones. Design, Setting, and Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023. Exposures: Percutaneous nephrolithotomy vs ureteroscopy. Main Outcomes and Measures: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery. Results: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery. Conclusions and Relevance: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

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Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children

Abstract

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