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The aim of the study was to establish the usefulness of ultrasound examination for imaging of stones dislocation in urinary tract after lithotripsy treatment. The study group included 335 children with urolithiasis treated in our Clinic since 1994 until 2005y. In the group were 295 (88%) children with nephrolithiasis and 40 (12%) children with ureterolithiasis. In the whole group 335 children there were performed 619 lithotripsy procedures--545 kidney and 74 ureter units. The ultrasound examinations were performed in each patient before, on the first and second day of the treatment and two months after using the Hitachi EUB 315 with 5Mhz transducer. In the ultrasound examinations after lithotripsy treatment: in 596/619 (96,3%) cases imaging of stones dislocation in urinary tract and urinary retention was possible.

Actually extracorporeal shock wave lithotripsy (ESWL) is the most frequent method in the treatment of urolithiasis in children. The aim of the study was to estimate the results of ESWL in children with urolithiasis. Between 1991 and 1999 y, in our Department 260 "reno-ureteral units" in 203 children were treated by lithotripsy. Totally of 518 ESWL procedures were performed. In general efficacy of ESWL was 88.08%, in children with single stone in kidney--97.80%., with multiple stones in kidneys--78.65%, in ureterolithiasis--71.88%. For complete recovery in patients mean 1.99 ESWL procedures were performed on 1 "reno-ureteral unit" on the average diameter of the stone/stones 13.3 mm.

Among 425 children with urolithiasis treated in the Paediatric Clinical Department of the National Research Institute of Mother and Child in Warsaw between 1976-1997, 50 of them i.e. 11.7% (26 boys and 24 girls) had recurrent urolithiasis. Patients' age was from 10 months to 16 years and 5 months. The number of recurrences of uroliothiasis before treatment in the Institute was from 1 to 8. Most of the children had numerous surgical operations, some of them excreted stones spontaneously. The etiology was determined in all cases. A metabolic cause of urolithiasis was found in 34 cases, i.e. 68% of the analysed group. They were as follows: idiopathic hypercalcuria--24 cases, uric acid urolithiasis--5 cases, cystynuria--4 cases, and incomplete distal renal tubular acidosis--1 case. Other reasons for urolithiasis were: infection--7 cases, idiopathic urolithiasis--8 cases, ren spongiosum--1 case. Prevention of recurrences depending on the etiology was successful. In 45 cases no recurrences were found. Recurrent urolithiasis was observed in 4 cases of cystynuria and in one case of incomplete tubular acidosis. The observation period was from 3-19 years.

Epidemiologic investigation did not show any special environmental combination causing urinary calculi creation. The disease concerns usually people between 25-50 year old. Most of the urinary calculi are compound of calcium oxalate and phosphate. In contaminated urine more often ammonia-magnesium phosphate. General constitutional factors having influence on urinary stones creation are specific gravidity, crystallization inhibiting factors concentration, hypercalcuria, urine acidity, hyperoxaluria and urinary tract infection. Unilateral, single urine stone is usually the effect of the local factors. Bilateral and multiple urinary stones are usually the effect of the local factors. Bilateral and multiple urinary stones usually are the effect of general constitutional and environmental factors. Complaints depend on the stone localisation, its dimensions and period of the disease. Nowadays most of the urinary calculi localised in the kidneys and ureters are treated with ESWL, PCNL and URS. Staghorn calculi are treated with the combination of PCNL and ESWL or operatively. Urinary stones localised in the bladder can be the consequence of descending ureteral stones, but usually they are created in the bladder as a consequence of the subvesical obstruction. The treatment is based on transurethral lithotripsy with simultaneous obstruction treatment by electrosurgery of the prostate or bladder neck or visual urethrotomy. Large and hard stones can be removed by cysto-lithotomy. Metafilaxis is the recurrences prevention, based first of all on diminution of crystalloid concentration and their solubility in the urine and providing crystallization inhibiting factors. Calculi composed of urine acid can be treated conservatively by their dilution.

For ages nephrolithiasis has been a widespread disease and clinical statistics prove that its morbidity index is still increasing, thus it becomes a social problem. Peak morbidity usually occurs at the age between 30 and 40, that is why many patients professionally active and creative have to leave their jobs for a long period. In contrast to earlier years, frequency of the disease occurrence in females is systematically increasing and nowadays it is only slightly lower from that in males. Etiology and pathogenesis of the disease is also not entirely explained. It is generally accepted that urinary stone formation is determined by multiple factors which affect first of all chemical composition and physical features of urine. Individual properties of the kidneys and urinary tract and infections especially with urease producing pathogens as well as environmental factors are also taken into account. The most favourable circumstances for nephrolithiasis occurrence is co-existence of all these factors.

Urolithiasis is a disease with complex and not fully explained etiology and pathogenesis. In its development there play role multiple factors, such as individual features of the kidneys and urinary tract, co-existing infections with urease-producing pathogens and environmental factors. Advance in the field of organ imaging has enabled development of new harmless diagnostic procedures that allowed for fast diagnosis, and current methods of treatment (USR, PCNL and ESWL) have significantly limited the number of surgical procedures performed because of urolithiasis. Introduction of these treatment methods markedly disturbed used for a long time scheme of management and in many cases it limited invasiveness of the treatment and shortened hospitalisation time. Unfortunately, not all urology departments in Poland have access to the newest methods of treatment, thus a percentage of patients treated with traditional methods is still high. Used nowadays methods of diagnosis and treatment have not fully solved a problem of urolithiasis metaphylaxis, and urolithiasis still remains a serious disease that requests close cooperation of the patients, nephrologist and urologist.

The objective of this study was to evaluate treatment of uric acid urolithiasis and prevention of uric acid stone formation in children. We treated 18 children (11 boys and 7 girls) with uric acid urolithiasis. Complete dissolution of stones was achieved in 16 children (89%). During a two year follow-up period, 14 children (78%) were recurrence free.