Review question

What is the evidence for treating stones of the kidney or ureter in children?

Background

Urinary stones occur in up to 5 in 100 children in high-income countries. These rates have been noted to be increasing. To treat urinary stones in children, urologists use medications, shock wave therapy, open surgery, and small scopes that are put into the bladder or through the skin. It is not clear how well each of these treatments work and what the side effects are.

Study characteristics

We included 14 studies with a total of 978 randomised children with stones in either the kidney or ureter, which connects the kidney to the bladder. The number of children in the studies varied from 22 to 221 children. There were seven trials of different types of surgery, four trials of medications and one study that compared medication with surgery. The amount of time the trials followed participants for ranged from one week to one year.

Key results

Shock waves versus medication to dissolve stones: we are uncertain about the effect on successful removal of stones, serious complications and the need for a second procedure to treat the stones.

Shock waves given slowly versus shock waves given fast: we are uncertain about the effect of slow shock waves on successful removal of stones. We are also uncertain about the effect on serious complications and the need for other procedures.

Shock waves versus treatment using a scope through the bladder to break up the stone: we are uncertain about the effect of shock waves on successful removal of stones compared to using a scope. We are also uncertain about the effect on serious complications and the need for other procedures.

Shock waves versus treatment using a scope through the skin into the kidney: shock waves are likely less successful in the removal of stones. Shock waves appears to reduce severe adverse events but more often secondary procedures are needed to remove all the stones.

Use of a scope through the kidney with a drainage tube afterwards versus without a drainage tube: we are uncertain about the effect on successful removal of stones, serious complications or the need for more procedures.

Use of a scope through the kidney with a regular versus very small (“mini”) tube through the skin: successful removal of stones are likely similar in both procedures. We did not find any data relating to serious adverse events. We are uncertain about the effect on the need for another procedure.

Alpha-blockers versus placebo with or without ibuprofen: alpha-blockers may increase successful removal of stones. We are uncertain about serious complications and the need for more procedures.

Quality of the evidence.

The quality of evidence for most outcomes was very low. This means that we are very uncertain about most of the review findings.