Background: Pediatric urolithiasis is increasingly managed with minimally invasive approaches. Retrograde Intrarenal Surgery (RIRS) offers a promising treatment option, though data on its outcomes in children remain limited. Objective: To evaluate the safety, efficacy, and predictors of outcomes following Retrograde Intrarenal Surgery (RIRS) in pediatric patients with renal or upper urinary tract stones. Methods: From September 2022 to August 2024, retrospective observational research was carried out at the Pakistan Kidney and Liver Institute and Research Center in Lahore. Included were pediatric patients (less than 14 years old) who had RIRS for upper tract or renal stones up to 27 mm. Demographics, stone features, surgical parameters, complications, and follow-up imaging results were among the data that were taken from electronic medical records. Statistical analysis was performed using SPSS v27; multivariate logistic regression identified predictors of postoperative complications and stone clearance. Results: A total of 24 pediatric patients underwent RIRS. Mean age was 9.0 ± 4.27 years; 18 (75.0%) were male. Stones were more often left-sided (14/24, 58.3%) and commonly located at multiple sites (11/24, 45.8%). RIRS was the primary treatment in 17 (70.8%) patients. Complete stone clearance was achieved in 17 (70.8%); access failure occurred in 4 (16.7%). Postoperative complications occurred in 5 (20.8%), including sepsis in 4 (16.7%). Anatomical abnormalities were seen in 5 (20.8%). Multivariate analysis showed anatomical abnormalities were protective against complications ( p = 0.037), while stone size >15 mm significantly reduced clearance odds ( p = 0.009). The predictive model for clearance was significant ( p = 0.013, R 2 = 0.519). Conclusion: RIRS is a safe and effective treatment modality for pediatric urolithiasis, achieving high stone-free rate with minimal complications. Anatomical abnormalities may reduce risk of complications, while larger stone size negatively impacts clearance. These findings support the selective use of RIRS in children with careful preoperative evaluation to optimize outcomes.
Nusrat et al. (2026) studied this question.