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New research is challenging the preference for ureteroscopy for the treatment of pediatric kidney stones in clinical practice, with study findings suggesting shockwave lithotripsy may provide similar rates of stone clearance with faster recovery time and better patient-reported outcomes.¹

The Pediatric KIDney Stone (PKIDS) Study included > 1000 children and adolescents who underwent kidney stone surgery at 31 North American centers and found ureteroscopy was associated with greater pain interference, urinary symptoms, and missed school 1 week after surgery compared with shockwave lithotripsy. Of note, there was no clinically meaningful difference in kidney stone clearance between the procedures.¹

Current guidelines from the American Urological Association recommend ureteroscopy or shockwave lithotripsy for pediatric patients with ureteral stones and kidney stones < 20 mm. However, this is based on low-quality evidence from observational studies and randomized clinical trials, none of which considered patient experiences after surgery.^1,2

“The PKIDS trial demonstrated that ureteroscopy and shockwave lithotripsy remove stones equally well and that patients having shockwave lithotripsy recover more quickly after surgery with less pain and fewer urinary symptoms. Our findings provide new information that allow for tailored approaches to kidney stone treatment for children and their families,” said Gregory Tasian, MD, MSc, director of the PKIDS network and an attending pediatric urologist in the division of urology at Children’s Hospital of Philadelphia.³ “Although future clinical trials are important, we hope that clinical practice guidelines will consider outcomes that matter to patients.”

An investigator-initiated, nonrandomized clinical trial embedded in the clinical care of children and adolescents undergoing kidney stone surgery between March 2020 and July 2023, PKIDS enrolled patients 8 to 21 years of age undergoing ureteroscopy or shockwave lithotripsy for unilateral or bilateral kidney stones at 31 medical centers in 22 US states and 1 Canadian province that participate in the PKIDS Network.¹

Treatment type was a clinical decision made by the urologist and patient or caregiver and was performed per the urologist’s discretion. The primary outcome was stone clearance, defined as the absence of any stone > 4 mm in the operated kidney or ureter on ultrasonography 6 (±2) weeks after surgery.¹

In total, the study included 1142 patients with a median age of 15.6 (interquartile range [IQR], 12.6-17.3) years, the majority of whom were female (60.4%) and White (77.4%). A total of 124 urologists treated 1069 and 197 kidneys or ureters with ureteroscopy and shockwave lithotripsy (n = 953 and n = 189 patients), respectively, with a median stone size of 6.0 mm (IQR, 4.0-9.0 mm).¹

Investigators noted ureteral stents were placed at time of index surgery for 841 procedures for 767 patients (80.4%) receiving ureteroscopy and for 6 procedures for 5 patients (2.6%) receiving shockwave lithotripsy.¹

Results showed stone clearance occurred in 474 patients who underwent ureteroscopy (71.2%; 95% CI, 63.8% to 78.5%) and in 105 patients who underwent shockwave lithotripsy (67.5%; 95% CI, 61.0% to 74.1%), although investigators pointed out this difference was not statistically significant (risk difference, 3.6%; 95% CI, −6.2% to 13.5%).¹

Compared with shockwave lithotripsy, ureteroscopy resulted in greater pain interference (T-score difference, 5.0; 95% CI, 2.3 to 7.8) and urinary symptoms (symptom score difference, 3.9; 95% CI, 1.2 to 6.7) 1 week after surgery. Further analysis revealed patients who had ureteroscopy missed more school (risk difference, 21.3%; 95% CI, 9.7% to 32.8%) and caregivers missed more work (risk difference, 23.0%; 95% CI, 11.0% to 35.0%) in the week after surgery.¹

“This evidence generated from contemporary clinical care calls into question current clinical practice, wherein most children and adolescents with kidney stones receive ureteroscopy,” investigators concluded.¹

References

1. 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

2. Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society guideline, part I. J Urol. 2016;196(4):1153-1160. doi:10.1016/j.juro.2016.05.090

3. Children’s Hospital of Philadelphia. Children’s Hospital of Philadelphia Researchers Lead Largest Comparative Study of Surgical Interventions for Children and Adolescents with Kidney Stones. Newswise. August 7, 2025. Accessed August 14, 2025. https://www.newswise.com/articles/children-s-hospital-of-philadelphia-researchers-lead-largest-comparative-study-of-surgical-interventions-for-children-and-adolescents-with-kidney-stones

The human papillomavirus (HPV) can cause six types of cancer. 

It’s responsible for almost all cervical cancer cases. HPV now causes the majority of oropharyngeal (throat) cancers. It can also cause anal, vaginal, vulvar and penile cancers. 

Yet new analysis from researchers at MUSC Hollings Cancer Center shows that most people are unaware of the connection between HPV and all of these cancers. 

That awareness is critical, said lead researcher Kalyani Sonawane, Ph.D., because it informs people’s decisions about whether to have their children vaccinated against HPV. 

When people make decisions about whether they want to get vaccinated or whether they want to get their child vaccinated, they are doing a risk-versus-benefit assessment. So it’s important for them to understand what can happen when someone gets HPV infection.” 

Kalyani Sonawane, Ph.D., lead researcher

Sonawane and colleagues used data from the Health Information National Trends Survey (HINTS), a survey conducted by the National Cancer Institute. They published their findings this week in JAMA Oncology. 

They found that about a third of people, nationally, aren’t aware of either HPV or the HPV vaccine. The lack of awareness tended to be clustered in states in the Midwest and South. 

For example, more than 40% of people in 13 states – including South Carolina – are unaware that there is a vaccine against HPV. 

The vaccine is the first and best defense against HPV-caused cancers. Research from Europe and the U.S., including research at Hollings, is showing a significant reduction in cervical cancer cases in young women.

The young women of today were children when the vaccine was first introduced and, therefore, the first group to be vaccinated. As they get older and enter the decades of life when cancer is most common, scientists expect to see even greater reductions in HPV cancers.

Cervical cancer is the bellwether because that type of cancer most commonly shows up when people are in their 30s or 40s. Oropharyngeal cancers, on the other hand, most often are diagnosed when people are in their 50s or 60s, so it will be some time before the first group that was vaccinated reaches this age. 

Sonawane noted that the biggest knowledge gap is in relation to oropharyngeal cancer. Across the nation, 70% of those who have heard about HPV didn’t know it causes oropharyngeal cancer. 

“HPV is linked with six different types of cancers, but cervical cancer seems to be the one that people are most aware of,” she said. That probably goes back to the original introduction of the vaccine in 2006. “It was first approved for girls and heavily marketed toward girls. Even the packaging was pink.” 

The vaccine has since been approved for boys, but rates of vaccination for boys remain lower than for girls.

“People think, ‘Oh, cervical cancer. I don’t need to get my boys vaccinated,’” Sonawane said. “Anecdotally, when we speak with pediatricians, they always tell us that when they ask a parent of a male child about HPV vaccination, the parents always say, ‘Oh, but he’s a boy.’” 

The pandemic interrupted many measures of preventive care, including HPV vaccination and screening for cervical, breast and colon cancers. A recent report from the American Cancer Society showed that screening for breast and colon cancers has since rebounded. Cervical cancer screening and HPV vaccination, however, have not.

“It just worries me how this is going to translate five years, 10 years down the line,” Sonawane said. “We are losing that critical opportunity of being able to vaccinate kids, being able to screen women at the right time and being able to catch these cancers early. Both primary and secondary prevention are suffering.”