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PRESENTATIONFlexible ureteroscopy for kidney stones in children.Lorenzo Defidio, Mauro De DominicisU.O.C. di Urologia Endoscopica e “Stone Center”, Ospedale Cristo Re, Roma, ItalySummaryEndoscopic evaluation and management of different pathological conditions involvingthe upper urinary tract using rigid or flexible endoscopes, is now readily feasible andhas been shown to be safe and efficacious even in the smallest children.Paediatricureteroscopic procedures are similar to their adult counterparts, so that basic endoscopicprinciples should be observed.Aims of the management should be complete clearance of stones, preservation of renal functionand prevention of stone recurrence.In order to select the most appropriate surgical treatment, location, composition, and size of thestone(s), the anatomy of the collecting system, and the presence of obstruction along with thepresence of infection of the urinary tract should be considered.Although extracorporeal shockwave lithotripsy (ESWL) is still the most important procedurefor treating urinary stones, advances in flexible endoscopes, intracorporeal lithotripsy, andextraction instruments have led to a shift in the range of indications.According to the location of the stone the treatment can be done with the rigid or flexibleureteroscope.To obtain stone fragments is essential for biochemical analysis. The stone composition may givesignificant information to prevent the high rate of recurrence, with dietary modification andspecific therapy.Successful outcomes for the retrograde treatment of renal calculi are similar to the onesobtained in the adult population (stone free rate 91-98%).The retrograde semirigid and flexible ureteropyeloscopy, using a small calibre ureteroscope, area valuable technique for kidney stones treatment in children. With excellent technique andmeticulous attention to details, the significant complications are rare.KEY WORDS: Urinary calculi; Flexible ureteroscopy; Children.Submitted 9 May 2009; Accepted 30 June 2009Endoscopic evaluation and management of the differentpathological conditions involving the upper urinary tractusing rigid or flexible endoscopes, are now readily feasibleand has been shown to be safe and efficacious evenin the smallest children.Reduction in size of the endoscopes, improvements inelectronic imaging systems, proliferation of ancillaryequipment and improvement in endourologic skillsamong paediatric urologists make endoscopic treatmentof paediatric urolithiasis the treatment of choice.Paediatric ureteroscopic procedures are similar to theiradult counterparts, so that basic endoscopic principlesshould be observed (1).Nevertheless, children pose specific technical challengesthat require accurate planning before endoscopy and thataffect the risks and outcomes of these procedures.Aims of the management should be complete clearanceof stones, preservation of renal function and preventionof stone recurrence. In paediatric patients with urinarystones, metabolic abnormalities conditions have beendemonstrated in up to 50% of cases whereas a variety ofanatomic anomalies have been found in about 30% ofchildren with urolithiasis. For this reason in addition tostone removal procedures, treatment of paediatricurolithiasis requires a thorough metabolic and urologicalevaluation on an individual basis (2).In order to select the most appropriate surgical treatment,location, composition, and size of the stone(s), theanatomy of the collecting system, and the presence ofobstruction along with the presence of infection of theurinary tract should be considered.Improvements in technology and growing experiencehave resulted in greater acceptance of minimally invasivetechniques for the management of paediatric stones andArchivio Italiano di Urologia e Andrologia 2010; 82, 153