Speaking of Urology: Patient-centered insights from the PKIDS trial in pediatric stone disease

In this episode of Speaking of Urology, Gregory E. Tasian, MD, MSc, MSCE, (Children’s Hospital of Philadelphia), Jonathan S. Ellison, MD, (Medical College of Wisconsin), and patient partner Annabelle Pleskoff reflect on the origins, design, and key findings of the PKIDS trial—a nearly decade-long, patient-centered study aimed at improving surgical outcomes for children and adolescents with kidney and ureteral stones.

PKIDS (NCT04285658) was a prospective, observational, real-world study that followed over 1,200 pediatric patients undergoing 1 of 3 treatments: ureteroscopy (URS), shockwave lithotripsy (SWL), or percutaneous nephrolithotomy (PCNL).^1,2

Unlike traditional research approaches driven by clinicians, PKIDS was shaped by patients’ and caregivers’ priorities, centering on the question: “Which surgical procedure works best for children and adolescents with kidney and ureteral stones, and how do these procedures affect their lives?”

This patient-centered approach led researchers to examine not just stone clearance, but also secondary outcomes like pain intensity, pain interference, anxiety, urinary symptoms, and sleep disturbance.

The trial found that stone clearance rates were similar across URS, SWL, and PCNL, with PCNL showing superior clearance for stones greater than 15 mm. However, patient-reported outcomes favored SWL and PCNL over URS in the first postoperative week, with URS associated with greater pain, urinary symptoms, anxiety, and sleep disturbances.

Tasian, Ellison, and Pleskoff emphasized that while PKIDS answered key questions about the comparative effectiveness and patient impact of these procedures, it also raised new research questions. Future studies will continue to rely on strong collaborations between clinicians, patients, and families to shape meaningful research and improve care.

You can subscribe to Speaking of Urology on Spotify, Apple Podcasts, or anywhere that podcasts are available.

REFERENCES

1. Ellison JS, Chu DI, Nelson CP, et al. Percutaneous nephrolithotomy vs ureteroscopy for kidney stones in children. JAMA Netw Open. 2025;8(6):e2516749. doi:10.1001/jamanetworkopen.2025.16749

2. Tasian GE, Chu DI, Nelson CP, et al. Ureteroscopy vs shockwave lithotripsy to remove kidney stones in children and adolescents: A nonrandomized clinical trial. JAMA Netw Open. 2025;8(8):e2525789. doi:10.1001/jamanetworkopen.2025.25789