Role of pediatric ureteroscopy for large renal stones: a systematic review and meta-analysis from EAU endourology
Talyshinskii A. Khairley G. Tur A.B. Gauhar V. Skolarikos A. Tursunkulov A. Ventimiglia E. Dragos L. De Coninck V. Somani B.K.
December 2025Springer Science and Business Media Deutschland GmbH
World Journal of Urology
2025#43Issue 1
Purpose: To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) for treating renal stones ≥ 1 cm in pediatric patients, and to assess its potential as a stand-alone alternative to percutaneous interventions. Methods: A systematic review and meta-analysis were conducted in accordance with a pre-registered PROSPERO protocol (CRD420251073155). A comprehensive literature search identified studies published in the last five years reporting outcomes of RIRS for renal stones ≥ 1 cm in patients under 18 years. Data were extracted on demographics, procedural characteristics, stone-free rate (SFR), complications, and auxiliary procedures. Meta-analysis of proportions using a random-effects model was performed. Heterogeneity was explored via meta-regression and sensitivity analyses. Results: Eight studies (two RCTs, four non-randomized comparative studies, and two single-arm cohorts) encompassing 361 patients were included. The pooled initial SFR was 79% (95% CI: 68–87%) with high heterogeneity (I² = 74.2%). Meta-regression identified stone multiplicity and lower pole location as significant contributors to heterogeneity, explaining 100% of between-study variance. The pooled auxiliary procedure rate was 20% (95% CI: 10–30%) and significantly influenced by the SFR cut-off used. Clavien-Dindo grade I–II complications occurred in 10% of cases (95% CI: 0–20%), while there were no ≥ grade III complications. The pooled operative time was 77.3 min, fluoroscopy time 71.6 s, and length of stay 1.6 days. Conclusions: RIRS is a feasible and generally safe option for managing large renal stones in children. However, variable definitions, heterogeneous populations, and limited high-quality evidence underscore the need for caution in interpretation. Future prospective, well-powered studies are warranted to better define RIRS outcomes and its role in contemporary pediatric stone management.
Large stone , Nephrolithiasis , Pediatric , RIRS , URS
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Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
European Association of Urology (EAU) Endourology section, Arnhem, Netherlands
Department of Urology, Fundació Puigvert, Carrer de Cartagena, Barcelona, Spain
Ng Teng Fong General Hospital, Singapore, Singapore
Asian Institute of Nephro-Urology, Hyderabad, India
Second Department of Urology, Sismanoglio Hospital, Athens, Greece
Department of Urology, Akfamedline University Hospital, Central Asian University, Tashkent, Uzbekistan
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
Department of Urology, AZ Klina, Brasschaat, Belgium
Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Department of Urology and Andrology
European Association of Urology (EAU) Endourology section
Department of Urology
Ng Teng Fong General Hospital
Asian Institute of Nephro-Urology
Second Department of Urology
Department of Urology
Department of Surgical Sciences
Department of Urology
Department of Urology
Department of Urology
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