8 hours ago
Kids Feel Less Pain With Underused Kidney Stone Treatment
Shockwave lithotripsy (SWL) for pediatric patients leads to less pain and fewer abnormal urinary symptoms after recovery than the widely used ureteroscopy (URS) procedure, according to research published in JAMA Network Open .
Researchers and other urologists said the findings confirm what they have observed: Fewer children and teens complain of pain and other symptoms in the days after the SWL than the URS, despite similar efficacy rates of each treatment. The incidence of kidney stones has risen in the past few decades, with the majority of these cases receiving URS.
'Patients are increasingly faced with this question of which procedure to choose and have very little information to guide them,' said Gregory Tasian, MD, director of the Pediatric KIDney Stone Care Improvement Network at Children's Hospital of Philadelphia, Philadelphia, and lead author of the study. 'All of the information that existed has been based on the ability to clear stones, which is important but doesn't account for other factors that patients and their parents find really important.'
The researchers undertook the study to gather more robust evidence for treatment protocols, Tasian said. Caregivers and patients were included in initial planning to determine relevant outcomes, including the measures of pain intensity and missed school, he said.
In a nonrandomized clinical trial, 1142 patients aged 8-21 years completed a questionnaire 1 week after their procedure. Those who received the shockwave procedure reported an average pain intensity score of 42.8 on a 56-point scale, about 7 points lower than for those who underwent URS.
Scores for pain interference with daily life in the shockwave group averaged 10 points lower than among the URS group. Stones were cleared in 71% of patients who received URS and about 68% of those who received SWL.
Average patient scores on a questionnaire assessing difficult and uncontrollable urination were about 4 points lower in the SWL group than in the URS group.
Patients who received SWL also missed 21% fewer school days, and their parents missed 23% fewer workdays than those who received URS. The study took place between 2020 and 2023 at 31 medical centers in the US and Canada. The majority of the population was women (60%) and White (77%).
'We learned from this research that pain is much greater with ureteroscopy, as are urinary symptoms,' said Tasian. 'And that really drives the patient experience.'
The American Urological Association (AUA) currently recommends URS and SWL equally for stones < 20 mm. But the guidance is based on low-level certainty evidence that does not include studies on patient experience, including pain levels.
The more frequent use of ureteral stents — tubes used to open and drain the urethra — in URS may account for the higher pain levels and disruptions to daily life, Tasian said.
Patients in the study undergoing URS needed a stent 80% of the time compared with 2.6% of those undergoing SWL and were 10 times more likely to need an additional surgery under general anesthesia to remove the stent.
Many hospitals do not have the lithotripter needed for the shockwave procedure, said Renea Sturm, MD, an assistant professor of pediatric urology at UCLA Health, Los Angeles, and an author of the study.
As a result, 'real-world implementation of the treatment may be a bit challenging,' Sturm said.
'I think a lot of us will want to change our practice, and this research helps us argue with the larger system' to purchase the equipment, said Kathleen Kan, MD, pediatric urologist at Stanford Medicine Children's Health in Los Gatos, California, who was not involved in the study.
She said that her patients who receive SWL are less likely to message her afterward with complaints of pain.
New AUA kidney stone guidelines are currently in development and expected to be released in 2026, a spokesperson for AUA said.
The study was funded by the Patient-Centered Outcomes Research Institute (PCORI). Kan and Sturm reported having no disclosures. Tasian reported receiving grants from the PCORI.
