Background: Pediatric urolithiasis is an endemic disease in certain parts of the world, namely Turkey and Far East. Metabolic and environmental factors, in addition to urogenital abnormalities, should be evaluated thoroughly each patient. The aims of management should be complete clearance of stones, treatment of urinary tract infections, preservation of renal function and prevention of stone recurrence. The giant bladder stone is not very common and it is usually associated with nutritional factors.
Case Report: A 3 year-old boy was admitted to our clinic with a 2-year history of recurrent urinary tract infections and urinary complaints like intermittent and painful voiding with terminal hematuria and sharp lower abdominal pain. On physical examination, the weight and height were 10 kg (below the 3rd percentile), and 85 cm (below the 3rd percentile), respectively. Direct urinary system X-ray study and intravenous urography (IVU) showed a giant bladder stone. In this case, we think that giant bladder stone is associated with nutritional factors and we were unable to find an underlying metabolic abnormality. Open surgery was performed to this patient. The bladder stone was 3.1 x 2.0 x 1.7 cm in diameter. Biochemical analysis showed that it was calcium oxalate stone.
Conclusions: Treatment of pediatric urolithiasis requires a metabolic and environmental evaluation of all patients. Obstructive pathologies have to be corrected and metabolic abnormalities should be treated. Also nutritional factors related with bladder stones must be considered. Open surgery remains the main treatment of giant bladder stones in children.

Keywords: endemic, urolithiasis, vesical