Review Summary of Recent “High-Level” Evidence on the Management of Pediatric Urinary Stones

The objective of this study is to summarize literature from the past 10 years on pediatric stone management with a focus on evidence generated from meta-analysis, systematic reviews, and randomized controlled trials (RCTs). Systematic literature search was performed on May 26, 2020. The search was on publications from the past 10 years and limited to meta-analysis, systematic reviews, and relevant RCTs on pediatric urolithiasis. Summary of literature was clustered to stone etiology, diagnostics, medical management, and surgical management. Summary of evidence was extracted with GRADE criteria used to standardize the level and quality of evidence reported. A total of 32 articles (19 systematic reviews with meta-analysis, 4 systematic reviews, and 9 relevant RCTs) were included. We summarized the genetic association with pediatric stone formation, diagnostics, medical management such as dissolution and medical expulsion therapy, procedural efficacy, as well as safety for extracorporeal lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy. We also evaluated each article’s approach to the comparison of outcome measures. Most of the available evidence was determined to be “very low” to “low” quality. Heterogeneity and low precision of the included studies led to downgrading using GRADE criteria. Relevant RCTs qualified as “high” to “uncertain” risk of bias in several domains of the study implementation and analysis. In the past decade, several systematic reviews, meta-analysis, and relevant RCTs that were mostly “very low” to “low” quality of evidence are available, and no definitive recommendations can be given to guide a pediatric urologist. We strongly recommend an individualized approach in the management of pediatric urolithiasis.