Pediatric urolithiasis is associated with considerable morbidity and recurrence. Since the aetiology is multifactorial, a thorough work-up is necessary to enable risk stratification. We report a case of a 14 year old obese male with symptomatic right ureteric calculus and right hydroureteronephrosis with as yet unidentified risk factors for susceptibility to stone formation. A month after undergoing a ureteroscopy with stenting elsewhere, he presented at our centre with complaints of flank pain and haematuria. Radiography revealed a mid-ureteric calculus with a stent in situ. The preliminary blood/urine work-up yielded no significant findings except for mild abnormalities in the lipid profile and red blood cells in the urine. A ureteroscopic lithotripsy was undertaken; however, a thorough metabolic work-up had to be deferred, as the required 24-hour urine samples have to be collected when the patient is on a daily routine. This case is being reported owing to its implications in the management of pediatric urolithiasis where a causative risk factor is yet to be recognized.