الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Over the past several years there have been an increasing
incidence of children with stones.
Causative factors of pediatric stone disease include:
metabolic causes, non metabolic causes and idiopathic stone
disease.
Hypercalciuria is major metabolic risk factor that occurs
in 34–97% of children with stones and an identifiable metabolic
etiology.
Other metablic causes include; hyperoxaluria, cystinuria,
hyperuricosuria, hypocitruria and hypomagnisuria.
Non metablic causes include; urinary infections, structural
abnormalities, diets, drugs and diseases which may lead to or
associated with urinary stones.
Clinical presentations of pediatric stone disease include:
pain, hematuria, infection, urinary retention or incidental
discovery of asymptomatic stones.
Urine analysis and urine culture, basic laboratory tests
and imagings are the base line for diagnosis of pediatric
urolithiasis.
Being high risk of stone recurrence; Children with
nephrolithiasis are a clear indication for metabolic evaluation. Imaging modalities include: conventional radiography
(KUB), ultrasongraphy, intravenous pyelography, computed
tomography, magnetic resonance imaging and renal radio
isotope scanning.
Recently, there has been interest in development of lowdose
CT techniques for use in the diagnosis of renal stones.
If a 24-hour collection is difficult, especially in younger
children, urinary standards based on single specimens, corrected to
urine creatinine concentration, have been developed.
Pediatric urolithiais could be managed nonsurgically and
surgically, stones associated with sever sepsis, colic resistant to
analgesics, urinary retention, obstruction of solitary kidney and
infected stones are examples of indications of urgent surgical
interventions.
Shock wave lithotripsy should be the treatment modality
for all renal stones less than 1 cm or <150 mm2, soft renal
stones (HU< 900 mm2 on CT scan) between 1 to 2 cm with
normal renal function, no infection and favorable anatomy.
Indications for PCNL in children are similar to those in
adults and include large burden stone more than 2cm.
Come into light the less invasive percutaneous access to
the pelvicalyceal cavities as the“mini-perc” technique which
worth its wide use with pediatric urolithiasis. Ureter-renoscopy, open surgical stone extraction and
laparoscopy are other invasive procedures for stone removal.
Bladder stones could be managed endoscopically but
open approach being easier and less operative time for large
stones.