Comparative effectiveness of paediatric kidney stone surgery (the PKIDS trial): study protocol for a patient-centred pragmatic clinical trial

Ellison, Jonathan S.; Lorenzo, Matthew; Beck, Hunter; Beck, Robert L.; Chu, David I.; Forrest, Christopher B.; Huang, Jing; Kratchman, Amy; Kurth, Anna; Kurth, Laura; Kurtz, Michael P.; Lendvay, Thomas S.; Tasian, Gregory E.

doi:10.1136/bmjopen-2021-056789

Cited by 14 publications

(6 citation statements)

References 64 publications

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“…24 The ongoing comparative effectiveness trial of URS, SWL and percutaneous nephrolithotomy conducted by the Pediatric KIDney Stone (PKIDS) Care Improvement Network will determine the clinical characteristics and operative processes that mediate the outcomes we examined. 25 Second, we did not consider nonopioid analgesics, alpha-blockers, and anticholinergics, which are often prescribed to alleviate stent symptoms. As potential modifiers of the stent experience, they deserve to be the focus of future comparative effectiveness studies.…”

Section: Discussionmentioning

confidence: 99%

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

et al. 2023

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Study Need and Importance: Ureteral stents cause pain and urinary symptoms for most patients; however, the impact of ureteral stents among pediatric patients undergoing kidney stone surgery is poorly understood. We determined the association between ureteral stents and emergency department (ED) visits and opioid prescriptions for youth having ureteroscopy or shock wave lithotripsy (SWL) to improve the evidence base that informs clinical decision-making for the rapidly growing population of patients with early-onset kidney stone disease. What We Found: In a retrospective cohort study conducted at 6 pediatric health systems that participate in PEDSnet, a clinical research network that aggregates electronic health data, we found that ureteral stents placed before or concurrent with ureteroscopy or SWL were associated with a 33% higher rate of ED visits and a 30% higher rate of opioid prescriptions within 120 days of the index procedure (see Table ). These associations were driven by stents placed before definitive surgery and were higher in magnitude for SWL. Our results strengthen the evidence for the American Urological Association and Endourological Society guidelines, which currently are supported only by expert opinion, to recommend against routine "pre-stenting." Limitations: Limitations introduced by the retrospective observational design include selection bias, unmeasured confounding, and lack of clinically important information such as surgical indications, infection, or whether the stent was left on a string. Interpretation for Patient Care: These results suggest that performing definitive surgery, when possible, rather than "pre-stenting" could reduce the number of pediatric patients who receive stents and reduce postoperative ED visits and opioid prescriptions. To this end, studies are needed to identify situations for which stents could safely be omitted.

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Section: Discussionmentioning

confidence: 99%

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

et al. 2023

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“…Examples of this value proposition include amplification of minority voices in research [1][2][3] and patient selection of outcomes and follow-up protocols for clinical trials. 4 One essential component of the engagement process is returning value to the communities and participants. In this way, engagement is sustained and cyclically reinforced (Figure).…”

Section: The Value Of Sustained Stakeholder Engagement In Clinical Re...mentioning

confidence: 99%

Establishing and Sustaining the Kidney Stone Engagement Core: A Model for Patient Engagement in Benign Urologic Disease

Shah,

Tasian,

Ellison

2024

Journal of Urology

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STAKEHOLDER engagement in research informs (1) patient-centered study questions, (2) optimal strategies for study recruitment and retention, and (3) dissemination activities to increase impact. Stakeholder engagement may be supported by community movements with a shared vision or by investigators in a particular disease space. 1 Several urologic malignancies, such as bladder and prostate cancer, have established patient engagement movements arising from advocacy and survivorship groups, for instance. 2,3 However, many common benign urologic diseases, such as nephrolithiasis, urinary tract infections, or hydronephrosis, often lack this infrastructure. Herein we describe a 2-year process to create the Kidney Stone Engagement Core (KSEC) with the goal of developing a patient-prioritized research agenda. We propose that KSEC could be a model for stakeholder engagement for urologists, particularly in those disease processes without a readily mobilized stakeholder base.

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“…It is anticipated that the Paediatric Kidney Stone Surgery (PKIDS) trial will be a valuable step towards addressing this gap. 88 …”

Section: Future Developmentsmentioning

confidence: 99%

Paediatric kidney stone surgery: state-of-the-art review

Juliebø‐Jones

Keller

Tzelves

et al. 2023

Therapeutic Advances in Urology

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While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.

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Comparative effectiveness of paediatric kidney stone surgery (the PKIDS trial): study protocol for a patient-centred pragmatic clinical trial

Cited by 14 publications

References 64 publications

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

Establishing and Sustaining the Kidney Stone Engagement Core: A Model for Patient Engagement in Benign Urologic Disease

Paediatric kidney stone surgery: state-of-the-art review

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