[Urolithiasis in children and adolescents]

Urolithiasis is rare in children. Contrary to adults, the great majority have an identifiable predisposing cause, metabolic, infectious or structural. Those causes often coexist. A complete assessment for all these factors is thus always indicated. Symptoms are often non-specific. The diagnosis must be considered in case of intense abdominal pain. The majority of urolithiasis in children are radiopaque. Ultrasonography looks for impairment of the urinary flow, signs of underlying uropathy and nephrocalcinosis. Non contrast spiral CT scan is more sensitive for soft stones and ureteral stones. Morphoconstitutional analysis of the calculi provides essential information on etiology, limitating further metabolic evaluation. If the stone seems unlikely to pass spontaneously, extra-corporeal shock wave lithotripsy is the first-line treatment for the great majority of children. Recurrence is common. Long-term medical treatment is essential. The first step is to maintain a high urine output by increasing water intake. Long-term prognosis is dependent on early diagnosis and on compliance to treatment.