Abstract Introduction ESWL in children remains controversial and any treatment decision reflects a balance between its benefits of non-invasiveness and effectiveness and its adverse effects that may be significant in pediatric patients. Aim of the work Our prospective study was conducted to To evaluate stone clearance in children post ESWL after 3 months. . Several factors interact to predict the clearance rate after ESWL. These range from the site, size and type of stone, to the operator’s experience, the machine’s design and condition and the patient selection. Patients and Methods Fifty children younger than 18 years with radio-opaque renal stones less than 20 mm were treated by ESWL as a first line treatment or as combined therapy. Pretreatment KUB and CTUT and Post treatment KUB films were used to follow up the clearance of fragments. Results Overall stone free rate was 90%. 12 % of the patients had clinically insignificant fragments and were instructed to follow up for the possibility of stone re-growth, the presence of microscopic hematuria and urinary tract infection. ESWL was unsuccessful in 10% of our patients and another treatment modality was chosen for them. Conclusion ESWL is recommended as the primary treatment of choice for pediatric renal stones < 20mms in all caliceal locations with high clearance rate Key Words: • Anatomy of the Kidney Special Focus on the Pelvicalyceal System • Basic principles of stone formation and composition; their relation to ESWL as a mode of stone treatment • Extracorporeal Lithotripsy Overview of Technology