New Evidence Expands the Pediatric Kidney Stone Treatment Conversation

For pediatric urologists helping families choose a procedure for kidney or ureteral stones, treatment success is only part of the decision. Families also want to understand how their child will feel after surgery, how quickly they can return to school and whether another procedure may be necessary.

New comparative evidence gives physicians better information for those conversations. The Pediatric Kidney Stone (PKIDS) study found no clinically meaningful difference in overall stone clearance between ureteroscopy and shockwave lithotripsy, but patients undergoing shockwave lithotripsy reported a more favorable experience during the first week after surgery.

“Removing the stone is obviously important, but it’s not the only outcome that matters to families,” says W. Robert DeFoor, MD, MPH, director of clinical research in the Division of Pediatric Urology at Cincinnati Children’s and a study author. “They are curious about the recovery process and how fast their child can resume everyday activities.”

For clinicians, the findings support broadening treatment discussions beyond stone clearance. Stone characteristics, anticipated stent use and postoperative recovery can all help inform shared decision-making with families.

Similar Stone Clearance Shifts Focus to Recovery Outcomes

The PKIDS study included 1,142 patients ages 8 to 21 undergoing kidney stone surgery at 31 centers across the United States and Canada. Estimated stone clearance approximately six weeks after treatment was 71.2% following ureteroscopy and 67.5% following shockwave lithotripsy—a difference that was not statistically significant.

The procedures differed more noticeably during recovery. At one week, ureteroscopy was associated with greater pain interference and urinary symptoms. Patients undergoing ureteroscopy also missed more school, and their caregivers missed more work, than those receiving shockwave lithotripsy. After the first week, no significant differences in patient-reported outcomes were detected.

Stent use may contribute to the postoperative experience. A ureteral stent was placed during the index surgery in 80.4% of patients undergoing ureteroscopy compared with 2.6% receiving shockwave lithotripsy. Nearly 30% of patients undergoing ureteroscopy subsequently underwent another procedure under general anesthesia for stent removal.

Stone Characteristics and Stent Use Help Individualize Treatment

The findings, however, do not establish shockwave lithotripsy as the preferred approach for every child. The study was nonrandomized and was not powered to identify treatment differences within stone size and location subgroups.

Stone size deserves particular consideration. Although researchers did not detect statistically significant differences in clearance by stone size in the primary analysis, clearance with shockwave lithotripsy decreased for stones larger than 10 mm when size was analyzed continuously. Investigators recommend discussing the potential for lower clearance with shockwave lithotripsy for these patients.

Read the full study: Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents in JAMA Network Open.

Cincinnati Children’s Brings Multidisciplinary Expertise to Pediatric Stone Care

For children who may benefit from additional evaluation or specialized pediatric stone expertise, Cincinnati Children’s provides medical and surgical management of pediatric kidney stone disease. Evaluation can include radiologic, metabolic, genetic and dietary testing based on the child’s history and stone disease. Treatment options include shockwave lithotripsy, ureteroscopy, ureteral stent placement and percutaneous nephrolithotomy. Second opinions are also available for families seeking additional guidance about treatment options.

To refer a patient to Cincinnati Children’s, complete our online referral form.

Patient experience remains central to these decisions. Adolescents with nephrolithiasis and parents helped PKIDS investigators identify outcomes meaningful to families, including pain, urinary symptoms, missed school and caregiver work absence. The findings give pediatric urologists a stronger evidence base for discussing not only which treatment can clear a child’s stone, but what each option may mean for recovery and daily life.

(Published October 2026)

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