LAUSR

INTRODUCTION Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instrumental, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy (URS) and can be done via natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age related anatomical differences impacts reported outcomes especially stone free rate (SFR) and complications. MATERIALS AND METHOD An electronic literature search from inception to 15 October 2021 was performed using Medical Subject Heading (MeSH) terms in several combinations on PUBMED, EMBASE and Web of science without language restrictions. 2022 articles were founded and 165 papers were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. RESULTS RIRS as of today is well established as a superior modality for all stones in all locations compared to ESWL both in children and adults. The passive dilation have decreased the need of active ureteral dilation, but the need to perform pre-stenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean towards its placement in most cases, but we do not know its long-term effects over the growth of children. Finally the stone free rate has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. CONCLUSION RIRS in pediatrics has crossed many milestones , yet many areas need further research and larger data is required to make RIRS the procedure of choice for renal stone management in children across all age group.