Medical aspect and minimal invasive treatment of urinary stones in children.

Despite its relatively uncommon incidence, management of the urinary stones in children poses a specific technical challenge to the urologist. Aims of the management should be complete clearance of stones, preservation of renal function and prevention of stone recurrence. In pediatric patients with urinary stones metabolic conditions have been demonstrated in up to 50% of cases whereas a variety of anatomic anomalies have been found in about 30% of children with urolithiasis. For this reason in addition to stone removal procedures, treatment of pediatric urolithiasis requires a thorough metabolic and urological evaluation on an individual basis. Obstructive pathologies along with the established metabolic abnormalities should be treated on time. Urine volume should be increased encouraging adequate fluid intake evenly distributed to the whole day and medical therapeutic agents which increase urine citrate levels may be considered in the medical management of hypocitraturia. In order to select the most appropriate surgical treatment, location, composition, and size of the stone(s), the anatomy of the collecting system, and the presence of obstruction along with the presence of infection of the urinary tract should be considered. Improvements in technology and growing experience have resulted in greater acceptance of minimally invasive techniques for the management of pediatric stones and currently urologists can benefit from the whole spectrum of stone management alternatives also in children. SWL is the first choice treatment for upper tract calculi while other minimally invasive methods have more specific indications. Although SWL is safe and efficient in the treatment of both renal and ureteral stones, ureteroscopy and PCNL in expert hands, can be successfully applied in appropriate cases. In fact due to the technically demanding nature of these procedures prior experience in the adult population is mandatory. With judicious application of these treatment modalities, excellent stone free rates with minimal morbidity could be obtained in this specific patient population. In patients with anatomical abnormalities open surgery will continue to be the preferred treatment alternative.