الفهرس 
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Abstract
Urinary stone disease in children is relatively rare but often associated with metabolic abnormalities that can lead to recurrent stone episodes.
Recent evidence indicates that urinary tract stones in children form at an increasing frequency. The incidence has been reported to range between 0.1% and 5%, and prevalence is noted to vary from 1 in 1,000 to 1 in 7,600 hospital admissions depending on the geographic region in the United States. In an epidemiological study from Turkey, where urinary stone disease is considered endemic, 17% of patients with urinary stone disease were noted to be younger than 14 years.
Although guidelines have already standardized the treatment of adults with stones, there is still a lack of consensus regarding etiology, natural history and management of pediatric urolithiasis. With continuing advances in technology stone management has evolved from open surgery into less invasive techniques, such as extracorporeal shock wave lithotripsy (SWL), ureteroscopy and satisfactory results are being reported with each minimally invasive alternative in children. Although several technical limitations and potential adverse effects are being proposed, SWL in general is regarded to be the first line treatment in the majority of urinary tract stones in children, as it is in adults.3–5 In a study urologists retrospectively analyzed the efficacy of SWL in the management of urinary tract stones, stratified according to location and size, in children.results revealed that SWL, with satisfactory stone-free rates and efficacy quotients in stones 2 cm or smaller can be offered as a first line treatment in children.
Presentation tends to be age-dependent, with symptoms such as flank pain and haematuria being more common in older children. Non-specific symptoms (e.g. irritability, vomiting) are common in very young children. Haematuria, usually gross, occurring with or without pain, is less common in children. However, microscopic haematuria may be the sole indicator and is more common in children. In some cases, urinary infection may be the only finding leading to radiological imaging in which a stone is identified .
With the advance of technology stone management has changed from open surgical approach to endoscopic techniques that are less invasive. Deciding the form of treatment depends on the number, size, location, composition and anatomy of the urinary tract . Currently, most paediatric stones can easily be managed by ESWL. Endoscopic treatment can be applied easily for ureteric stones.
Significant technological advances have been made in the management of ureteric calculi. The newer semirigid, fibreoptic ureteroscopes can now be passed with minimal trauma and in many cases without dilatation.Advances in intracorporeal lithotripsy, namely, laser lithotripsy have also facilitated ureteric stone fragmentation while greatly decreasing the possibility of ureteric injury during stone fragmentation and removal.The Holmium laser, in particular, provides a very powerful yet safe lithotripsy mechanism. As commented by Winfield,(21) the intrinsic property of the Holmium laser had provided unsurpassed stone fragmentation including calcium oxalate monohydrate and cystine stones which could be difficult even for the pulsed dye laser. These changes allow for rapid, safe and in most cases economic way of stone removal.
The management of urolithiasis in children is becoming more similar to that of adults as instrumentation, catheters, stents, and equipment for stone manipulation and treatment improve as well as miniaturize. Nowadays open surgery is usually reserved for cases with anatomical abnormalities or failed endourological attempts, while SWL in general is considered to be the method of choice for managing the majority of urinary tract stones in children.
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