Imaging during pediatric stone management and follow up.

purposeThe rising incidence of pediatric urolithiasis, especially in adolescents, underscores the need for optimized imaging strategies in diagnosis, management, and follow-up. This study aims to review the current imaging modalities used in pediatric stone disease, evaluate their efficacy, safety, and radiation risks, and explore strategies for reducing radiation exposure while ensuring effective clinical outcomes.

methodsThis narrative review synthesizes existing literature and clinical studies on imaging modalities, the use of radiological imaging during shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL), with a focus on radiation safety and adherence to the “As Low As Reasonably Achievable” (ALARA) principles. Data on radiation exposure, stone-free rates, and complication rates related to ultrasound-guided and fluoroscopy-guided approaches were reported and discussed.

resultsUltrasound-guided SWL, URS, and PCNL demonstrated comparable efficacy to fluoroscopy-guided techniques, with stone-free rates ranging from 82% to 96%, and significantly reduced radiation exposure. Introduction of radiation-reducing protocols, such as pre-fluoroscopy checklists and dose optimization techniques, led to up to 88% reduction in radiation dose during endourological procedures. Furthermore, metabolic evaluation and tailored preventive strategies were shown to lower recurrence rates, minimizing the need for repeated imaging.

conclusionImaging in pediatric urolithiasis must balance diagnostic efficacy with long-term safety. Ultrasound-guided interventions and radiation-reducing strategies effectively minimize radiation risk without compromising clinical outcomes. Comprehensive metabolic management further supports reduced imaging frequency. Interdisciplinary collaboration is essential to optimize pediatric stone care while adhering to radiation safety principles.