The aim of this study was to evaluate the effects of concomitant urinary system abnormalities (CUSA) on presenting features, radiological characteristics, metabolic risk profile, follow-up burden, and treatment requirements in children with pediatric urolithiasis. The medical records of 308 pediatric patients diagnosed with urolithiasis and followed at a tertiary university hospital between January 2014 and December 2020 were retrospectively analyzed. Patients were divided into two groups according to the presence (n=110) or absence (n=198) of CUSA. Demographic characteristics, clinical presentation, infection profile, radiological and metabolic findings, number of imaging studies during follow-up, and medical and surgical treatment requirements were evaluated. At least one CUSA was identified in 35.7% of the study population. While there were no significant differences between the groups regarding age at diagnosis or sex distribution, a family history of stone disease was less common in patients with CUSA (50.0% vs. 62.6%; p=0.040). Fever (p=0.014), pyuria (p<0.001), positive urine culture (p<0.001), and a history of urinary tract infection (p<0.001) were significantly more frequent in patients with CUSA. Although no significant differences were observed in stone size or number of stones, ureteral (p=0.014) and bladder stones (p<0.001) were more common in the CUSA group. During follow-up, the rate of at least one episode of hypocitraturia was significantly higher in patients with CUSA (p=0.034). In addition, the total number of ultrasonographic examinations (p<0.001), hospitalization rate (p<0.001), surgical intervention (p=0.005), and Double-J stent requirement (p=0.011) were significantly higher in this group. Final stone-free rates were similar between the groups. The presence of concomitant urinary system abnormalities in children with pediatric urolithiasis is associated with an infection-predominant clinical presentation, differences in stone localization, metabolic risk factors emerging during followup, and increased monitoring and intervention requirements. These findings emphasize the importance of early identification and closer multidisciplinary follow-up of patients with concomitant urinary system abnormalities.

Keywords: Pediatric urolithiasis, urinary tract stone disease, associated urinary tract disease, congenital urinary tract anomalies, urinary tract infection