Ellison Jonathan S, Chu David I, Nelson Caleb P, DeFoor W Robert, Ziemba Justin, Huang Jing, Luan Xianqun, Kurtz Michael, Ching Christina B, Dangle Pankaj P, Schaeffer Anthony J, Sturm Renea, Wu Wayland, Bayne Christopher, Fernandez Nicolas, Chua Michael E, DeMarco Romano, Ellsworth Pamela, Augelli Brian, Bi-Karchin Jing, McCune Rebecca D, Vatsky Seth, Back Susan, Wang Zi, Beck Hunter, Kurth Anna, Kurth Laura, Pleskoff Annabelle, Forrest Christopher B, Tasian Gregory E, Rove Kyle, Sparks Scott, Nelson Eric, Schlomer Bruce, Krill Aaron, Tong Ching Man Carmen, Taylor Abby, Ramachandra Puneeta, Stec Andrew, Casale Pasquale, Coplen Douglas, Janzen Nicolette, Bagley Krystal, Denburg Michelle, Dickinson Kimberley, Laberee Rosemary, Lorenzo Matt, Selman-Fermin Antoine, Dos Santos Joana, Grant Campbell, Kraft Kate, Meenakshi-Sundaram Bhalaajee
Department of Urology, Medical College of Wisconsin, Milwaukee.
Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
JAMA Netw Open. 2025 Jun 2;8(6):e2516749. doi: 10.1001/jamanetworkopen.2025.16749.
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.
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.
Percutaneous nephrolithotomy vs ureteroscopy.
Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery.
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.
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.
基于专家意见，临床指南推荐对肾结石直径20毫米及以上的儿童和青少年进行经皮肾镜取石术或冲击波碎石术，未提及输尿管镜检查作为一种替代方法。
比较经皮肾镜取石术与输尿管镜检查在患有肾结石和/或输尿管结石的儿童和青少年中的临床及患者报告结局。
设计、地点和参与者：这项前瞻性队列研究在美国和加拿大的31个医疗中心进行。参与者包括2020年3月16日至2023年7月31日期间接受肾结石和/或输尿管结石手术的8至21岁患者。
经皮肾镜取石术与输尿管镜检查。
术后6（±2）周通过超声评估结石清除情况。次要结局包括术后1周患者报告的结局。
该研究纳入了1039名符合条件的患者（中位年龄15.6岁[四分位间距，12.5 - 17.3岁]；女性629名[60.5%]；黑人40名[3.8%]；西班牙裔128名[12.3%]；白人792名[76.2%]）。126名泌尿科医生对98个肾脏和/或输尿管进行了经皮肾镜取石术，对1069个进行了输尿管镜检查，其中36个因结石大于15毫米接受经皮肾镜取石术，43个接受输尿管镜检查。经皮肾镜取石术的结石清除率为67.2%（95%置信区间，46.0% - 88.4%），输尿管镜检查为73.4%（95%置信区间，69.4% - 77.4%），差异无统计学意义（风险差异，-6.2%；95%置信区间，-27.7%至15.4%）。对于大于15毫米的结石，经皮肾镜取石术的结石清除率为94.0%（95%置信区间，83.3% - 100%），输尿管镜检查为55.0%（95%置信区间，32.9% - 77.1%），差异有统计学意义（风险差异，39.0%；95%置信区间，14.4% - 63.5%）。与输尿管镜检查相比，经皮肾镜取石术术后1周的疼痛强度（T评分差异，-5.42；95%置信区间，-10.38至-0.46）、疼痛干扰（T评分差异，-5.88；95%置信区间，-11.02至-0.75）、焦虑（T评分差异，-5.74；95%置信区间，-9.26至-2.22）、心理压力体验（T评分差异，-7.90；95%置信区间，-13.13至-2.67）、睡眠障碍（T评分差异，-5.57；95%置信区间，-8.56至-2.58）和泌尿系统症状（症状评分差异，-6.37；95%置信区间，-11.71至-1.03）均显著更低。
与输尿管镜检查相比，经皮肾镜取石术在儿童和青少年中结石清除率相似且生活体验更好，并且与大于15毫米肾结石的更高结石清除率相关。需要未来进行一项有足够效力的前瞻性临床试验来再次证实这些结果。
