Urolithiasis, the formation of urinary stones, is increasingly prevalent in pediatric populations and poses unique challenges in terms of surgical management due to anatomical and developmental differences. This chapter provides an overview of various surgical interventions for urinary stone disease in children, considering factors such as stone characteristics, obstruction, patient age, and health status. The surgical approaches discussed include extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, ureterorenoscopy, open and minimally invasive stone surgeries, and endoscopic transurethral cystolitholapaxy. The rationale, techniques, outcomes, and potential complications associated with each surgical modality are examined to guide decision-making and optimize treatment outcomes.