Speaker
Gregory Tasian, MD, MSc, MSCE
Associate Professor of Surgery and Epidemiology
Children’s Hospital of Philadelphia
Keywords
PKIDS, PCORnet, Comparative Effectiveness Research, Kidney, Kidney Stone, Pediatrics
Key Points
- The demographic of people who get kidney stones has changed over the past 30 years, which has left gaps in evidence base to support care. Increasingly, kidney stones affect children and adolescents, particularly adolescent girls. The Pediatric KIDney Stone Care Improvement Network (PKIDS) was founded to address this evidence gap.
- PKIDS study was a prospective observational cohort study across 30 sites nationwide answering the participant-identified research question, what is the best surgery for my child who has a kidney or ureteral stone? Surgery for kidney stones usually includes minimally invasive surgical procedures including ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL).
- The participant population included males and females, 8-21 years of age, undergoing URS, SWL, or PCNL for the removal of at least one kidney and/or ureteral stone.
- The primary outcome was a clinical outcome of stone clearance defined by the absence of any stone under 4mm measured by ultrasound 4-8 weeks after surgery, consistent with standard of care. The secondary outcomes were the physical, social, and emotional health measured by patient-reported outcomes, as well as urinary symptoms, missed school/work, and ED visits, repeat surgery, admissions.
- The trial took place between April 2020-October 2023. There were a total of 1,228 participants enrolled, with 1,070 receiving URS, 197 receiving SWL, and 98 receiving PCNL. There was a 50% completion of ultrasounds within the specified window due to the COVID-19 pandemic; the trial extended the window to 16 weeks with a 75% completion of postoperative ultrasound.
- The PKIDS trial supports revisions of the American Urological Association guidelines including: A new size threshold of 15mm for kidney stones; recommend SWL over URS for stones less than 10mm; consider possible greater stone clearance and worse patient experiences with URS for kidney stones 10-15mm; remove SWL from guidelines for stones greater than 15mm; recommend PCNL over URS for stone greater than 15mm.