Background: The incidence of urolithiasis in the pediatric population is on the rise. Urolithiasis in the pediatric age group, although occurring less in adults, causes considerable morbidity. The role of ureteroscopy (URS) in the management of calculus anuria could be primary or deferred. The deferred URS after initial ureteral stenting or percutaneous drainage is the standard one. However, the remarkable progress in the manufacturing of ureteroscopes and lithotripters favored the primary URS. Objective: This study aimed to evaluate the results of primary versus deferred URS for management of obstructive calculus anuria (OCA) in children in previous literatures. Methods: We have searched literature in the American National Center for Biotechnology Information (NCBI), PubMed, Google scholar, Egyptian bank of knowledge, and science direct. Conclusion: Primary URS is a definitive stone management technique and an appropriate option that can reduce hospital stay, prevent multiple anesthesia, and alleviate the costs in children with OCA when performed by skilled endourologists. However the deferred URS is a favored procedure for management of calculus anuria in pediatric patients compared to primary URS.