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The advances in technological equipments in the last decade for the treatment of pediatric stone disease has significantly improved outcomes. A variety of nephroscopes of different sizes which can be used for different age groups are available on the market to treat kidney stones. Flexible ureteroscopes, ultrathin ureteroscopes, and other sizes of semirigid ureteroscopes are also available for the treatment of ureteral and upper urinary tract calculi in children. In addition to the advancement of the finer instruments, laser technology with different powers has improved fragmentation of the stones. The advancement of stone retrival devices and baskets facilitated the procedures by decreasing the complications. Open stone surgery has almost disappeared and together with laparoscopy, it is only reserved for stones in children with anatomical abnormalities (pelvic kidneys, spinal deformities, etc.). Beyond surgical alternatives, although its use has proportionally decreased over time, shock wave lithotripsy is here to stay as a valuable option. Nevertheless, personalized management is the key to treat pediatric stone disease and it is the task of the surgeons to find out the best alternative according to the size and location of the stone, and age and body size of the child. Future technical improvements are also awaited and will soon improve the efficiency of the current endourological procedures. [ABSTRACT FROM AUTHOR]

With increasing incidence of pediatric urolithiasis over the past two decades, surgical management poses specific challenges for urologists because of the high risk of stone recurrence in this population. Keeping this in mind, management aims should be complete stone-free status, preservation of renal function, and prevention of stone recurrence. The incidence of metabolic problems is up to 50%, and ∼30% of cases involve anatomic anomalies. Therefore, in addition to stone removal procedures, treatment of pediatric urolithiasis requires a thorough metabolic and urologic evaluation on an individual basis. Obstructive pathologies and established metabolic abnormalities should be managed. Urine volume should be increased by encouraging adequate fluid intake, and medical therapeutic agents to increase urinary citrate levels may be considered. To select the most appropriate surgical treatment, the location, composition, and size of the stone(s), the anatomy of the collecting system, and the presence of obstruction or any infection in the urinary tract should all be considered. Improvements in instrument technology and increasing experience with adult cases mean that all contemporary endourologic procedures are currently being applied in the management of pediatric urolithiasis in a safe and effective manner. Shockwave lithotripsy is still the first choice for the majority of cases involving upper tract calculi; other minimally invasive methods such as ureterorenoscopy and percutaneous nephrolithotomy require more expertise, but can be successfully applied for excellent stone-free rates with minimal morbidity. In patients with complex and large stones as well as anatomic abnormalities, open surgery will continue to be the preferred treatment option for children. [ABSTRACT FROM AUTHOR]

Abstract: Percutaneous nephrolithotomy (PCNL) revolutionized stone surgery decades ago. However, it is still a challenging surgical technique that requires professional preparation and knowledge of possible problems and their solutions. We illuminate the recent literature on indications for PCNL, preoperative diagnostics, required patient preparation, and the different techniques of the whole procedure, including positioning the patient, gaining access to the collecting system, disintegrating the stone, and finishing the operation. All up-to-date discussions are included. Recognition and handling of possible complications are described in detail. PCNL is one of the most powerful instruments of the urologist for stone treatment. In an expert''s hands, the procedure is gentle, fast, and efficient. To become an expert, continuous training with supervision is necessary. However, further development of instruments and techniques enables surgeons to perform more complex cases and to broaden the indications. To gain a successful performance, exact exploration and preparation of the patient is decisive. In the rare case of severe complications, a well-trained team of nurses, radiologists, and anesthesiologists is priceless. [Copyright &y& Elsevier]