Editing AUA: Stone Surgery (2016) (section)

== Pediatrics ==

* Overall, more generous use of SWL

=== Ureteral stones ===
* '''Uncomplicated ureteral stones ≤10 mm'''
** '''Observation +/- MET using α-blockers should be offered [similar to adults]'''
** '''URS or SWL for ureteral stones who are unlikely to pass the stones or who failed observation and/or MET, based on patient-specific anatomy and body habitus [different than adults''' '''where URS preferred for distal or mid ureteric stones]'''
* '''Routine stenting prior to URS for ureteral stones is not recommended [similar to adults]'''

=== Renal stones ===
* '''Active surveillance with periodic ultrasonography may be utilized in pediatric patients with asymptomatic and non-obstructing renal stones'''
* '''Total renal stone burden <20mm'''
** '''Options: SWL or URS [different than adults''' where stone location is important''';''' in adults, for lower pole stone >10mm, SWL is not recommended, all other stones <20mm can be treated with URS or SWL]
* '''Total renal stone burden >20mm'''
** '''Options: both PCNL and SWL are acceptable treatment options [different than adults,''' no role for SWL for total renal stone burden >20mm]
*** '''A non-contrast, low-dose CT scan should be obtained prior to PCNL''' '''[similar to adults]'''
*** '''If SWL performed for total stone burden >20mm, placement of a ureteral stent or nephrostomy tube is recommended to prevent postoperative renal obstruction. [different than adults''', no indication for routine stent with SWL]

=== Open/laparoscopic/robotic surgery ===

* '''Except in cases of coexisting anatomic abnormalities, open/laparoscopic/robotic surgery for upper tract stones should not be routinely performed.'''

* Series in adults have suggested that laparoscopic approaches may compare favorably to percutaneous techniques for large or staghorn renal stones, but in children, these approaches should be considered secondary or tertiary options for treatment of renal or ureteral stones since more conventional procedures, including SWL, URS, and PCNL, have high rates of success and lower risks of serious complications.
* '''The primary exception to this statement is in the pediatric patient with one or more renal or ureteral stones and a co-existing anatomic anomaly, such as UPJ obstruction''', '''UVJ obstruction and duplication anomalies with an obstructed ectopic ureter.''' In such cases, open, laparoscopic, or robotic-assisted laparoscopic surgery is indicated to remove the stone(s) and repair the primary anatomic defect.