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Management and Outcomes of Small Non-Obstructive Kidney Stones in Children: A Systematic Review
Suchita Rajan, BA.
Childrens Hospital, Milwaukee, WI, USA.
Project Title: Management and Outcomes of Small Non-Obstructive Kidney Stones in Children: A Systematic Review
Introduction and Objectives: Pediatric kidney stone disease affects approximately 1% of children and imposes substantial healthcare costs through emergency visits and procedures. Optimal management of small non-obstructive stones remains unclear: observation may avoid surgical intervention but carries a risk of renal colic. We aimed to systematically review outcomes of observation for small non-obstructive pediatric kidney stones, hypothesizing that observation carries measurable risks of adverse events but may avoid surgical intervention in selected patients.
Methods: We followed PRISMA guidelines, including PROSPERO registration, to perform a systematic review through Ovid MEDLINE, Web of Science, CINAHL, Scopus, and CENTRAL up to February 2025. Eligible studies included randomized controlled trials, cohort studies, and observational studies of patients <18 years with small non-obstructive stones reporting at least one of the following: spontaneous stone passage, surgical interventions (ureteroscopy, percutaneous nephrolithotomy, extracorporeal shock wave lithotripsy), urinary tract infections, stone size, or residual stone burden. Two reviewers independently assessed studies for inclusion and extracted data, with a third reviewer resolving disagreements. Event counts and percentages were summarized for categorical outcomes.
Results: Twelve studies including 1382 patients (median 80.5; age 0-18 years) published between 2004 and 2024 were included. Most stones were calcium-based, followed by uric acid, cystine, struvite, and mixed types. Seven studies reported spontaneous stone passage, with 380 of 826 patients passing stones (46.0%; median 35 per study). Surgical intervention occurred in 332 of 1296patients (25.6%; median 30 per study). Urinary tract infections occurred in 34 of 350 patients (9.7%), and stone growth was reported in 155 of 582 patients (26.6%). In two studies including 111 children with residual fragments, 24.3% experienced stone growth, 38.7% had symptomatic episodes, and 29.4% required secondary intervention.
Conclusions: Observation of small, non-obstructive kidney stones in children appears generally safe, with nearly half passing spontaneously and a low risk of infection. However, a substantial proportion of patients still required surgical management. Findings support individualized treatment planning and highlight the need for high-level prospective studies to define the optimal role of observation.
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