International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis

The aim of this study was to develop the sixth set of guidelines in a series produced by the International Alliance of Urolithiasis (IAU), providing a clinical framework for the management of paediatric patients with urolithiasis based on the best available published evidence. All recommendations were synthesised following a systematic review and critical appraisal of the literature indexed in the PubMed database from January 1952 to December 2023. Each recommendation was graded according to a modified GRADE methodology. The guidelines were ratified by Panel Members after thorough review and discussion of the evidence. The recommendations address key topics including aetiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgicalinterventions, prevention, and follow-up. Notable parallels exist in the management of primary stone episodes between paediatric and adult patients, particularly regarding conservative treatment approaches and technological advancements facilitating less invasive stone removal. Additionally, preventive strategies aimed at reducing recurrence – such as adequate hydration, well-structured dietary modifications, and the selective use of pharmacological therapies – are anticipated to yield favourable outcomes in paediatric stone formers. Given the variability in the severity of metabolic abnormalities and anatomical anomalies, a meticulously planned, close follow-up programme is essential for each paediatric patient to mitigate the risk of future recurrences.

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