Objective <p>The aim of this study was to evaluate the outcomes of retrograde intrarenal surgery (RIRS) in the pediatric population and to investigate the factors affecting surgical success.</p> Materials and methods <p>The medical records of pediatric patients who underwent RIRS at Hacettepe University Hospital between 2014 and 2023 were retrospectively reviewed. Patient age, stone number, stone size, stone location, stone density measured in Hounsfield units (HU), presence of hydronephrosis, preoperative and postoperative double-J stent (DJS) placement, and use of a ureteral access sheath (UAS) were analyzed in relation to stone-free rates at 6 weeks and final stone-free outcomes.</p> Results <p>A total of 59 patients (62 renal units) who underwent 64 surgical procedures were included in the study. The mean age of the cohort was 7.48 ± 5.5 years. High-grade hydronephrosis was present in 40.6% of patients, and multiple stones were detected in 33.9% preoperatively. Residual stones were observed in 43.7% of patients in the early postoperative period, while the final stone-free rate was 64.1%. A trend toward a higher residual stone rate was observed in patients with stone density ≥ 700 HU (<i>p</i> = 0.10). Although the use of a ureteral access sheath appeared to reduce the need for additional intraoperative procedures, it did not significantly improve stone-free rates (<i>p</i> = 1.00). Ureteral access sheath placement was significantly more common in patients aged ≥ 5 years (<i>p</i> = 0.021). Postoperative febrile urinary tract infection occurred more frequently in patients younger than 5 years of age (<i>p</i> = 0.025).</p> Conclusion <p>RIRS is a feasible and effective treatment option for pediatric urolithiasis, providing acceptable stone-free rates with low complication rates. However, special attention should be paid to postoperative febrile urinary tract infections, particularly in patients younger than 5 years.</p>