The incidence of pediatric urolithiasis is increasing worldwide significantly. There are many aspects in which pediatric lithiasis differs from adult urolithiasis. Child’s metabolic condition and anatomic structure contribute to medical planning and surgical planning respectively reducing the rate of surgical intervention repetition and protecting renal functions. In children, preventing the recurrence of stones has the same importance as removing them. Therefore, determination of the metabolic condition causing the stone formation is significant. The first step in treatment is increasing fluid intake, reduction of pain on diagnosis, by analgesics and antispasmodics. Asymptomatic small stones (<4–5 mm) may pass spontaneously. Medical expulsive treatment has been reported to increase the rate of stone passage, So medical expulsive treatments promoting stone passage (α-blockers) may be used in children. Supersaturation of calcium and oxalate or reduced levels of inhibiting citrate or magnesium are responsible for calcium oxalate stones formation. Calcium oxalate stones are common in children (70%). Minimally invasive surgical options that are highly effective in providing stone-free status reduced the interest in SWL; however, minimally invasive techniques and SWL have comparable stone-free rates. Moreover, the advantages of SWL include shorter post-procedural hospitalization, detection of less post-procedural readmission rates and is cheaper. Although SWL considered first line in treatment of pediatric renal stones, PNL can have a significant role in certain cases. According to the European Association of Urology guidelines, PNL is recommended as primary treatment option for large renal stones (> 20 mm). Also, for stones > 10 mm stones of the lower renal pole. SWL resistant stones as well