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Disposable stone retrieval devices are an inherent element of modern-day stone management. Efforts are being made in several different areas to improve the efficiency of stone removal. Ureteral access sheaths with pressure control features as well as suction capabilities are being explored as one such mechanism. Additional efforts are being made to improve stone basket design, grasping capabilities, and deployment mechanisms. Finally, bioadhesives are being developed to potentially improve the capability to extract otherwise difficult small stone fragments and debris from the kidney., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Infected kidney stones refer to stones that form because of urinary tract infections with urease-producing bacteria, secondarily infected stones of any composition, or stones obstructing the urinary tract leading to pyelonephritis. The mainstay of treatment of infection stones is complete stone removal. Kidney stones that obstruct the urinary tract and cause obstructive pyelonephritis are also frequently referred to as infected stones. Obstructive pyelonephritis is a urologic emergency as it can result in sepsis and even death. Infection stones and obstructive stones causing pyelonephritis are different disease processes, and their workup and management are described separately., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The presentation of urolithiasis is often dramatic, but rarely is it more anxiety provoking than during pregnancy. The evaluation and the intervention are often approached with trepidation as the health of the mother and the fetus must be taken into account. The typical diagnostic course and surgical management used in the nonpregnant population must be reevaluated in the expectant mother. Failure to promptly diagnose and manage urolithiasis during pregnancy may have adverse consequences for mother and child. The authors present a review of the relevant anatomic and physiologic changes of pregnancy as they affect stone disease and outline options for radiologic evaluation and surgical management.

Childhood urolithiasis remains endemic in certain parts of the world, namely, Turkey and the Far East. The prevalence of nephrolithiasis in North American children varies widely among geographic regions and accounts for 1 per 1000 to 1 per 7600 pediatric hospital admissions. Stones occur in children of all ages. The clinical manifestations of stone disease are often more subtle in children when compared with the dramatic adult presentation. This article discusses the evaluation and medical management of pediatric stone disease.

Patients with nephrolithiasis may have coexistent diseases that play a causative role in stone formation. A stone event may be the initial manifestation of the disorder and the urologist may play a major diagnostic role. Regulation or correction of the disorder may eradicate or dramatically attenuate stone activity. In some patients, metabolic abnormalities persist, however, and the therapeutic strategies that were reviewed in this manuscript may need to be implemented. Stone disease may also be induced by drugs that are used to treat a number of disease processes. When this occurs, the drug will usually need to be discontinued and alternative therapy should be instituted.

The management of urolithiasis in pregnancy can present complex challenges to the urologist. However, if the principles discussed above are followed, these difficult clinical problems can be approached in a rational manner.

Imaging studies used for the detection and characterization of urinary tract calculi are presented in this article. Comparisons of traditional imaging studies are made with noncontrast helical CT scanning, the most recent addition to stone imaging. Imaging findings for noncontrast helical CT and an approach to dealing with various combinations of CT studies are also presented.

The genetics, pathophysiology, diagnosis, and treatment of cystinuria are discussed in this article. Newer chemotherapeutic and surgical options that are used to treat this disease process also are reviewed. The authors suggest a multimodal approach in the treatment of cystinuria and cystine calculi.

Urolithiasis in childhood is of diverse etiology requiring carefully planned individualized diagnostic and management protocols. The efficiency in diagnosis and management of urolithiasis in childhood follows a learning curve, especially when using the more recent technical innovations for management of urinary calculi. With current technical sophistication of transurethral and percutaneous techniques and ESWL, management of urolithiasis during childhood should be relatively straightforward as monotherapy using a single modality or as a combined approach with one or more techniques, saving open surgical intervention for situations where the new technology is either unavailable or inappropriate, or when surgical reconstruction of the urinary tract is necessary to forestall recurrent calculus formation. Postoperative morbidity after management of urinary calculi during childhood appears insignificant; calculus recurrence is uncommon. Long-term postoperative follow-up is mandatory, especially after using the newer technical innovations for urinary calculus management during childhood.

Ultrasonography is now well established as an accurate, noninvasive means of evaluating the genitourinary tract in patients of all age groups. Ease, speed, and portability of real-time have made ultra-sonography one of the most readily accessible imaging procedures. Most authorities concede that it is best utilized as a complement to other imaging modalities. This article describes and illustrates the many pathologic processes involving the upper genitourinary tract that can be accurately diagnosed utilizing real-time ultrasonography.

In summary, all patients with infection stones should undergo a preoperative diagnostic evaluation in order to identify any underlying metabolic abnormalities. All organisms infecting the urinary tract should be identified and appropriate antibacterial therapy instituted 48 to 72 hours preoperatively. Surgery should be undertaken not only to remove all stones but to correct any anatomic abnormalities within the kidney in order to improve urinary drainage and to diminish urinary stasis and infection. Postoperatively, all recurrent urinary tract infections should be treated vigorously. Continual efforts should be made to maintain a sterile urinary tract. All identified metabolic abnormalities will require appropriate treatment.