How is the treatment chosen?
The treatment of a stone in a child depends on its size and location (in the kidney or in the ureter, the tube that carries urine to the bladder), as well as on its composition and the kidney’s anatomy. For symptoms and causes, see kidney stones in children.
Whichever method is used, the cause is investigated in every child: a stone that passes or is removed is sent for analysis, and a metabolic workup is done.
Options compared
The table is based on the European Association of Urology (EAU) recommendations for stones in children.
| Method | When it is considered | Notes |
|---|---|---|
| Watching | A single, symptom-free stone in the lower part of the kidney | Regular follow-up |
| Medication to help passage (alpha-blocker) | Ureteral stone | Off-label in children; evidence on benefit is mixed |
| ESWL | Single ureteral stone under 10 mm (first choice); kidney stone up to 20 mm | No incision; sometimes more than one session is needed |
| Ureteroscopy | Ureteral stone not suitable for ESWL | Endoscope passed through the urethra |
| RIRS (flexible ureteroscopy) | Kidney stone under 20 mm, in any location (alternative) | Endoscope passed through the urethra, no incision |
| PCNL, mini-PCNL | Stone over 20 mm in the renal pelvis or a calyx | Through a small opening in the back; instruments sized for the child |
| Open or laparoscopic surgery | Rarely; stones that cannot be cleared by other methods | Laparoscopy works for stones that did not respond to ESWL and PCNL |
Watching and medication
Some stones cause no symptoms. For a single, symptom-free stone in the lower part of the kidney, watching is a reasonable first step. During this time, the doctor checks your child regularly.
For ureteral stones, a medication called an alpha-blocker is sometimes given to help the stone pass. In children, this use is not on the medicine’s label, and the evidence on its benefit is mixed.
ESWL
In shock wave lithotripsy (ESWL), waves delivered from outside the body break the stone into small pieces that then pass with the urine. It is the first choice for a single ureteral stone under 10 mm. Kidney stones up to 20 mm across are also well suited to ESWL. Sometimes more than one session is needed to clear the stone fully.
Ureteroscopy and RIRS
A thin endoscope is passed through the urethra, and the stone is broken with a laser and removed. Ureteroscopy is chosen for ureteral stones that are not suitable for ESWL. Reaching inside the kidney with a flexible scope (RIRS) is an alternative for kidney stones under 20 mm.
Percutaneous nephrolithotomy (PCNL, mini-PCNL)
The surgeon reaches the kidney through a small opening in the back and removes the stone. It is recommended for stones over 20 mm in the renal pelvis or a calyx. In children, the instruments are chosen to fit their smaller anatomy. The version done with thinner instruments is called mini-PCNL.
Open and laparoscopic surgery
Open surgery is rarely done in children. Laparoscopic surgery works well for stones that could not be cleared with ESWL and PCNL.
When a stone and fever occur together
If a stone is blocking the flow of urine and your child has a fever, this is an emergency. First, the urine trapped in the kidney is drained urgently; the stone itself is treated after the infection has cleared.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- Fever or chills together with flank or belly pain (infection in a blocked kidney): seek urgent care without waiting for a planned visit
Call your local emergency number (112 in Europe, 911 in North America)
Note for pediatricians and family doctors
EAU Urolithiasis Guidelines (2026, pediatric section): offer SWL as first-line treatment to children with a single ureteral stone under 10 mm if localization is possible (strong); ureteroscopy is a feasible alternative for ureteral stones not amenable to SWL (strong). Renal stones up to 20 mm (~300 mm²) are ideal for SWL (strong); offer PCNL for renal pelvic or calyceal stones over 20 mm (strong); retrograde renal surgery is a feasible alternative for renal stones under 20 mm in all locations (weak). MET with alpha-blockers is off-label in children, and the evidence on its benefit is contradictory. Per the guideline's general recommendation, decompress the collecting system urgently in sepsis with an obstructing stone and delay definitive stone treatment until sepsis resolves. Complete a metabolic evaluation based on stone analysis in all children (strong).
What happens at the visit?
- The stone's size, location and number, and any kidney dilation, are assessed with ultrasound, and with low-dose CT when needed.
- The treatment is chosen together with the family, based on the stone, the child's age and the child's anatomy.
- A metabolic workup is planned to find the cause, and any stone that passes or is removed is sent for analysis.
Frequently asked questions
Can medication help the stone pass?
For ureteral stones, a medication that helps the stone pass (an alpha-blocker) is sometimes used. In children this is an off-label use and the evidence on its benefit is mixed, so the doctor decides.
Which method is best?
There is no single best method for every child. The choice depends on the stone's size, location and composition, the kidney's anatomy and the child's age.
Will my child need open surgery?
Open surgery is rarely done in children. Laparoscopic surgery is an option for stones that could not be cleared with ESWL and PCNL.
Related topics
Sources
This information is for educational purposes and does not replace medical advice. Decisions about your child’s treatment are made with the doctor after an examination.
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