The Changing Paradigm of Paediatric Urolithiasis in Nepal: A Bibliometric Analysis and Scoping Review with Global Comparative Context

1. Design This study follows the JBI methodology for scoping reviews and is reported according to PRISMA-ScR (Tricco et al., 2018), with the bibliometric component reported according to Donthu et al. (2021) [16]. Eligibility is defined using a Population–Concept–Context (PCC) framework. 2. Eligibility criteria Population: children and adolescents aged 0–18 years with confirmed urolithiasis managed in Nepal. Concept: any epidemiological, clinical or management aspect of the condition. Context: any Nepali healthcare setting, any year, any language. Single case reports were charted separately for historical framing and never pooled with the clinical series. Sources without extractable paediatric data, conference abstracts, and reviews (retained only for citation-chaining) were excluded. 3. Information sources and search strategy PubMed, Scopus, Web of Science, Google Scholar (first 200 results of simplified single-concept strings) and NepJOL were searched using combinations of condition, population and setting terms, with backward and forward citation chaining of included sources. No date or language restriction was applied. Searches were last updated in August 2026. 4. Study selection and data charting Two independent reviewers screened all records and extracted data using a standardised, piloted charting form; disagreements were resolved by discussion. Selection is documented in a PRISMA-ScR flow diagram reporting per-database search strings, run dates and record counts. Figure will summarises this process across the four PRISMA-ScR stages. At identification, records were retrieved separately from each of the five sources (PubMed, Scopus, Web of Science, Google Scholar, NepJOL) and supplemented by records identified through backward and forward citation chaining of included sources. After de-duplication, records were screened at title/abstract level against the population–concept–context criteria in Section , and the remaining reports were assessed in full text. Records were excluded at full-text stage for lacking extractable paediatric-specific data, for being conference abstracts without a linked full report, or for being reviews retained only for citation-chaining rather than data extraction. This process yielded the nine Nepal-specific sources charted in this review: seven clinical series pooled in the quantitative synthesis (287 patients, 1988–2023, six institutions; and two single case reports charted separately as historical or illustrative context and not pooled (Ashworth & Hill, 1988; Paudyal et al., 2025 ). Exact per-database and per-reason record counts will be inserted from the final, date-stamped search log before journal submission, consistent with PRISMA-ScR reporting item 12. 5. Statistical analysis methods Consistent with JBI scoping-review guidance for a small, heterogeneous, single-arm literature, the primary synthesis is descriptive: counts, proportions and means/standard deviations are reported as published in each source, without harmonising outcome definitions across studies. No random-effects meta-analytic pooling, I² heterogeneity statistic or Egger’s test was performed—the charted evidence base (seven series) falls far short of the number required for these to produce a stable estimate. One exploratory inferential test was applied: a two-sided Fisher’s exact test comparing the proportion of bladder versus upper-tract stones between the earliest charted era (Sharma et al., 2004, reporting 1988–1994 data) and the pooled 2016–2023 series. Fisher’s exact test was chosen over chi-square given small expected cell counts in the earlier era. This test is reported in Section 3.3 together with an explicit discussion of why its result should not be read as evidence of a population-level secular trend . For context, we note that the appropriate methods for a full quantitative burden-of-disease trend analysis—Joinpoint regression, Average Annual Percentage Change (AAPC) estimation and Bayesian age-period-cohort modelling—are those used by Global Burden of Disease-based analyses of paediatric urolithiasis. These methods require continuous incidence or prevalence time series, which do not currently exist for Nepal; we recommend them explicitly as the target methodology for a future Nepal-specific burden study built on prospective registry or claims data rather than a charted literature base. 6. Bibliometric methods The bibliometric component draws on the comprehensive Web of Science Core Collection analysis of paediatric stone disease published by Chen et al. (2024) (1,208 publications, 2000–February 2024), supplemented by targeted PubMed, Google Scholar and NepJOL searches for Nepal-affiliated output and by cross-reference to smaller published bibliometric exercises. Annual trends, country and institutional contribution, and keyword co-occurrence patterns were obtained from the published maps and tables rather than re-executed de novo.