Non-Invasive Modalities in the Management of Kidney Stones in Children: A Systematic Review

M. Rafiq Kurniawan; Irfansyah Irfansyah

doi:10.35582/ijcpch.v7i4.56

M. Rafiq Kurniawan Departement of Urology, Teungku Peukan Regional General Hospital, Southwest Aceh, Indonesia
Irfansyah Irfansyah Departement of Urology, Teungku Peukan Regional General Hospital, Southwest Aceh, Indonesia

DOI: https://doi.org/10.35582/ijcpch.v7i4.56

Keywords: kidney stones, Urolithiasis, Pediatrics, Non-invasive therapy, ESWL

Abstract

Background: The incidence of pediatric nephrolithiasis is increasing worldwide. Pediatric urolithiasis is predominantly associated with metabolic etiologies and carries a high risk of recurrence. Non-invasive approaches are therefore prioritized to ensure long-term safety and preservation of renal function.

Objective: This systematic review aimed to evaluate the effectiveness and safety of non-invasive modalities in the management of pediatric kidney stones.

Methods: A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for studies published between January 2015 and December 2025. Studies involving patients <18 years with kidney stones managed using non-invasive approaches, including observation, conservative therapy, pharmacotherapy, and extracorporeal shock wave lithotripsy (ESWL), were included. Study selection followed PRISMA 2020 guidelines. Data were extracted and analyzed narratively.

Results: Eight studies met the inclusion criteria. Ultrasonography was recommended as the first-line diagnostic modality. Active surveillance and adequate hydration were effective for small stones (<4–5 mm), with high rates of spontaneous resolution. Pharmacotherapy, including potassium citrate and thiazides, was effective for selected metabolic abnormalities and reduced recurrence. ESWL achieved high stone-free rates (up to approximately 86% after multiple sessions), with generally mild and transient complications. Stone size and location, patient age, and metabolic factors were key determinants of treatment success.

Conclusion: Non-invasive modalities are effective and safe as first-line management for pediatric urolithiasis. Individualized management based on comprehensive clinical and metabolic evaluation is essential to optimize outcomes and prevent recurrence.