Abstract

Diagnosis and treatment of urinary stone has specific properties and differences in children. Appropriate urinary evaluation before minimally invasive intervention increase success rate while decrease complication rate in pediatric stones. Ultrasound and plain X-ray can diagnose the vast majority of urinary stone in children. IVU may improve the decision between SWL and endoscopic intervention for pediatric renal stone. CT is not necessary for the vast majority of children with urinary stone. The main aim of endoscopic treatment is to sustain maximum stonefree rate with minimal morbidity, because recurrence rate and repeated endoscopic intervention rate is high in such children. The age of the patient, size and localisation of the stone, stone composition, urinary obstruction, urinary tract infection, experience of surgeon and availability of endourological instrument of centre are the most important factors on management strategy in children with urinary stone.

The majority of pediatric urinary stones can be treated by such a minimally invasive approach as SWL, URS, RIRS or PNL. In pediatric renal stone, SWL should be the first choice when soft, stone burden is low (<15 mm) with normal renal anatomy. However, the first choice should be RIRS when hard, stone burden is low (<15 mm) with normal renal anatomy. If the stone burden is high (>15 mm) or even low but associated with unfavorable kidney anatomy (narrow intrarenal pelvis, caliceal diverticula, norrow infundibulum, etc) PNL is the best choice of treatment. In pediatric ureteral stone, the first choice should be SWL and second be the URS when stone is located in proximal ureter. However, the first choice should be URS when stone is located in distal ureter. Stone-free rate increases in PNL, URS and SWL respectively, while complication rate decreases in SWL, URS and PNL respectively. Life-threatening complication risk is high if the surgery done by an inexperienced surgeon due to small, fragile and mobile pediatric kidney and ureter. Gold standart rule in minimally invasive interventions: Never heart and push urinary tissue, and do not do any procedure when not seeing the area. Esperience on detailed urinary anatomy, appropriate instruments specifically designed for children and experience on pediatric intervention are crusial to decrease complication and re-intervention rate in children with urinary stone.