Ureteroscopy in pediatric urolithiasis: techniques, challenges, and outcomes.

PURPOSE: Pediatric ureterorenoscopy (URS) has gained a prominent role in the management of pediatric urolithiasis, reflecting significant technological advances and growing clinical experience. The aim of this manuscript is to provide an overview regarding the literature on pediatric URS. METHODS: A narrative synthesis was performed based on the literature review on indications for pediatric URS, the scope armamentarium, auxiliary equipments, emerging laser alternatives, surgical technique, access and exit strategies. RESULTS: With advancements in miniaturized ureteroscopes and ancillary equipment, URS has become increasingly feasible, effective and safe in pediatric patients, including those under five years of age. Current guidelines recommend URS as the first-line treatment option for distal ureteral stones and renal pelvis stones sized 10–20 mm. Promising results are shown in the literature for fluoroscopy-free URS in children. CONCLUSIONS: Further research is required focusing the long-term outcomes of pediatric URS as well as the effect of novel ureteroscopes, lasers, and ancillary instruments on surgical efficacy.