Introduction

There is a considerable body of literature dedicated to adult stone disease but very little written about pediatric stone disease. While nephrolithiasis is less prevalent in children, it can be associated with significant morbidity. This chapter will touch upon the pathophysiology, the surgical management, and the current state of evidence base data, particularly long-term outcomes of pediatric stone disease.

Epidemiology

Childhood urolithiasis varies widely around the world both in the composition and location of the stones. For example, it is endemic in the Far East and Turkey where the stones are primarily ammonium uric acid stones. In European countries, the majority of stones found in children are composed of struvite and organic matrix that are frequently the result of urinary tract infections from bacteria containing urease. In the USA, infection-related stones are rare. Stone composition in the USA is mostly calcium-based.

In North America and other developed countries, nephrolithiasis in children has remained stable over the last 20 years. In Europe and the United States, the incidence of stone disease is similar, ranging from 0.13 to 1.0 cases per 1000 hospital admissions. The disease always varies geographically within countries. For example, the incidence tends to be higher in the warm climates of the southeastern United States and California. The incidence is also higher in areas with immigrants from countries where stone disease is endemic. The ratio of boys to girls affected by stone disease is 1.2–1.7:1 in the USA and 1.9–3:1 in the UK.