الفهرس 
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Abstract
Urolithiasis in children is a rare disease representing about 1% of all patients with urolithiasis, yet a serious one that necessitates proper management. The urolithiasis incidence is affected by many variables such as age, race, dietary habits, fluid intake, and geographical distribution. The formation of stones is affected mainly by metabolic abnormalities, improper fluid intake, infection, some drugs, and urine PH. The stones may be asymptomatic, or they may present with renal colic, dysuria, hematuria, and fever. The stone disease can lead to serious complication if not managed. Radiological investigations play the main role in the diagnosis of stones. The gold standard modality is non-contrasting computed tomography. However, plain X-Ray and ultrasonography represent important modalities for diagnosis of stones in children. This prospective study was conducted on 24 pediatric patients who were admitted to Urology Department Tanta University Hospital during the period from August 2021 to February 2023 with renal stones above 20mm in its maximum diameter except in lower calyceal stones we included stones more than 10mm.We also included smaller renal stones with failed ESWL or Flexible URS. The stone burden, age of the patient and availability of instruments were considered during the choice of our equipments. Dilatation up to 24 Fr was needed in patients with large stone burden, older children, but younger children dilatation was done up to 16 Fr. Laser lithotripsy was the main method of stone fragmentation. Holmium laser was used in 10 cases, ultrasonic lithotripsy was used in 6 cases while pneumatic lithotripsy was used in 8 cases. Postoperative DJ stent inserted in 15 patients while open tip ureteric catheter inserted in the remaining 9 children. The primary Stone free rate was 87.5% as 21 children were stone free 4 weeks later. The larger the stone size, the longer the operative time. The operative time ranged from the operative time ranged from 55.0 – 110.0 min. The intra operative complications that were reported include mild bleeding and calyceal perforation. While the postoperative complication fever, heamaturia with no cases of colonic injury or urine leakage. Only one patient needed a blood transfusion and hospital stay was 2 days in 79.2% of the study.